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1) What kind of business is this?  [required]
2) What is your relationship to the business?  [required]
3) Is the business public or private?  [required]
4) What are the annual revenues of the business?  [required]
5) How many total employees does the business have?  [required]
6) If you are a debtor, what type of debts are you seeking protection from, or if you are a creditor, what type of debts are you trying to recover? Check all that apply.  [required]
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7) If you are a debtor, are you interested in reorganizing or liquidating?  [required]
8) Have you ever filed for bankruptcy before?  [required]
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9) If yes, what chapter was filed?
10) In what year was the bankruptcy filed?
11) Please indicate how you would prefer to to pay for the services of an attorney, should you hire one to help you with your legal matter. Note: there is no charge to sumbit your request.  [required]
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First Name: [required]
Last Name: [required]
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