Your Name* If you are completing this form on behalf of someone else, please provide that person's name in this field.
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Can Attorney Fleysher text you at this number?* Where do you currently live?
How were you referred to us?* Please provide a brief description of the situation you're calling for help with.* You can share any background information you think the attorney may find useful or helpful in understanding the circumstances that motivated you to reach out to us. You can discuss the details in your conversation with the attorney.
Have you lived here in Florida for more than 2 years?* Do you currently own or rent where you're living?* What type of debt do you have?* Check all that apply...
Are you keeping up with the minimum payments?* What is your Marital Status?* Are you looking to file your case alone or jointly with your spouse?* If most of the debt is joint, or if your spouse has a lot of their own debt, it's probably better to file together. If not, the individual filing of one spouse does not affect the credit profile or assets of the other non-filing spouse.
How many people in your household?* Your household size includes you, your spouse (if married), and any dependents (i.e., kids or adult parents you support).
Employment Status* Are you currently...
Spouse's Employment Status* Is your (husband/wife) currently...
How many vehicles do you have in your name?* We want to know how many cars, trucks, motorcycles, boats, RVs, etc. the caller has registered or titled in their name. This can include vehicles the caller cosigned but is not using.
Is Vehicle 1 Leased, Financed, or Owned "Free & Clear"? Is Vehicle 2 Leased, Financed, or Owned "Free & Clear"? Is Vehicle 3 Leased, Financed, or Owned "Free & Clear"? Is Vehicle 4 Leased, Financed, or Owned "Free & Clear"? Is Vehicle 5 Leased, Financed, or Owned "Free & Clear"? Is Vehicle 6 Leased, Financed, or Owned "Free & Clear"? Do you have any pending lawsuits or claims you expect to get money from?* Examples include car accidents, slip and falls, insurance claims, wage claims, social security/disability, worker's comp, etc.
Have you repaid any debts to friends or family members for more than $1,000 in the last year?* Do you have more than $5,000 in any bank, investment, or financial account?* Retirement accounts (i.e., IRAs, 401(k)s, 403(b)s, Pensions, etc.) are exempt and are not included in this question.
How many different bank, financial, or investment accounts do have in your name?* This includes checking, savings, business bank accounts, PayPal, CashApp, Venmo, Crypto accounts, or any other investment or financial accounts.
If you have not scheduled your appointment yet, please provide a few convenient days/times for your call and our receptionist will call or text you to confirm the appointment. Preferred Days Preferred Times
That's it! Just click or tap on the SUBMIT button below and you're all set. 
