4725 Excelsior Boulevard
Suite 402
St. Louis Park, MN 55416
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Charles A. Bassford Jr.
James T. Hanvik
Vicki J. Lunde
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Five Minute Client Questionnaire for Free Consultation
Information about you and your family
Your Name
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Phone Number
Cell Phone Number
How many people live in your household?
How long have you lived in Minnesota?
Employment information
I am unemployed
My spouse is unemployed
Job position
Gross Annual Income
Do you receive income from ANY other source (unemployment, child support, alimony, rental income, social security disability etc.)?
Yes
No
If yes, what is the source of the income?
If yes, how much gross income per year?
I do not own any real property (house, condo, duplex, vacant lot)
Property Address
When did you buy the property?
How much did you pay?
What does the county value your property at now?
What is your mortgage balance?
I do not have any mortgages on my property
Monthly payment
Months behind (if applicable)
If you have more than one mortgage, please list the balances below
Second Mortgage Balance
Second Mortgage Monthly payment
Second Mortgage Months behind (if applicable)
Third Mortgage Balance
Third Mortgage Monthly payment
Third Mortgage Months behind (if applicable)
Fourth Mortgage Balance
Fourth Mortgage Monthly payment
Fourth Mortgage Months behind (if applicable)
Do you have any homeowner’s dues?
Yes
No
What is your monthly dues payment?
Are you current on your dues payments?
If not, how much do you owe to catch up?
Do you own any other homes or land?
Yes
No
If yes, briefly describe and list the value of Property #2
If yes, briefly describe and list the value of Property #3
If yes, briefly describe and list the value of Property #4
Motor Vehicles
Do you own any motor vehicles (car, truck, motorcycle, etc)?
Yes
No
Vehicle #1 Year, Make, Model & Miles
Vehicle #1 Value
Amount of loan against Vehicle #1?
Vehicle #2 Year, Make, Model & Miles
Vehicle #2 Value
Amount of loan against Vehicle #2
Vehicle #3 Year, Make, Model, Miles
Vehicle #3 Value
Amount of loan against Vehicle #3
Debt
What types of debt do you have?
Credit Card
Student Loan
Tax Debt
From what tax year?
Did you file a tax return?
Yes
No
If so, what year did you file a tax return?
Other categories of debt?
Other categories of debt - Estimated Amount
Name
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