Bankruptcy Advice Centre

ENQUIRY FORM

( Information submitted on this form will be used for Private Purposes only )

Your Email address:

Your Full Name:

Full Name
Postcode
Home Number
Work Number
Mobile Number
Email Address
Income (after Tax) PA ($)
Unsecured Debt ($)	*Do not include here amounts owed for vehicles or mortgages (secured debts)
Fines and/or Child Support arrears ($).
Property Owner?	*No Yes
Jointly owned?	*No Yes
	* We can still assist you if you are not a property owner.
If ‘yes’ Value of Property ($)
If ‘yes’ How much is owed ($)
Vehicle Owner?	No Yes
If ‘yes’ Value of Vehicle ($)
If ‘yes’ How much is owed ($)
Dependants
Comments
G T Lean & Associates take your privacy very seriously.

WE CAN ALSO BE CONTACTED DURING WA OFFICE HOURS Freecall 1800 738 353 Phone (08) 9227 8353 Fax (08) 9227 7566 Email mail@bankruptcyadvice.com.au