Santa Rosa Bankruptcy Attorney

*For an evaluation to determine if you should sue creditors or debt collectors, please supply the following information which will be of assistance in my answering your questions and concerns.

The information you supply is CONFIDENTIAL.

Name:
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Address:
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Bothered by creditors:	Yes No
Name of Original Creditor:
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Name of Debt Collector:
Amount Owed:
Please detail your experience with the creditor and/or debt collection and how that experience has adversely affected your life.:
Dear Mr. Dechant: I am interested in some advice concerning the harassment I have been receiving from my creditors and/or the debt collectors who have assumed the collection of the account. I understand that your review of this material is at no charge to me, and I assure you that the information I have given on this form is truthful and pertains to me. I understand that until I sign a written contract with you or another attorney concerning this matter, I am not represented by an attorney. I understand that until specific action is taken on my behalf, I am not protected from actions by my creditors even though I may have submitted this form and spoken with an attorney.
	Yes, I Agree to these terms Yes No
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Ed Dechant, Attorney at Law | Two E Street - POB 1708, Santa Rosa, CA 95402 | 707-604-0042 | Fax:707-869-1118
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