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Intake Questionnaire - Bankruptcy Lists
Also available in PDF | MS Word
Filing for bankruptcy requires exhaustive information about your credit history, past income tax returns and various other financial forms. The document below is designed to help collect information about your company and assist your attorney in assessing your company's financial situation in the event of bankruptcy. If you or your business are filing for bankruptcy or contemplating filing for bankruptcy, you should collect the following documents (if they exist) and provide them to your attorney.
Legal name of Company: _________________________ Location of Company headquarters: _________________________ _________________________ _________________________ Mailing address, if different: _________________________ _________________________ _________________________ Addresses for other locations: _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ Telephone number: _________________________ E-mail address: _________________________ Federal tax identification number: _________________________ State tax identification number: _________________________ Legal status of the Company (corporation, partnership, sole proprietor, other): _________________________ If the Company is a corporation, list: Number of shares of preferred stock: _________________________ Number of shares of common stock: _________________________ List person(s) with power to vote 20 percent or more of Company's securities: _________________________ List corporation(s) with power to vote 20 percent or more of Company's Securities: _________________________ Is the Company publicly held? _________________________ If publicly held, what is your SEC File number? _________________________ Has the Company used any trade or assumed names in the last six years? _________________________ List all prior bankruptcies, if any: _________________________ List any pending bankruptcies of partners, affiliates, officers or guarantors, if any: _________________________ Name, address, account number of financial institution(s) where the Company maintains accounts: _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ List the amount of insurance on any real property owned by the Company: _________________________ Name of agent: _________________________ List the amount of insurance on any personal property owned by the Company: _________________________ Name of agent: _________________________ Are you current on payroll taxes (FICA, withholding, unemployment)? _________________________ If not, describe status of delinquent taxes: _________________________ _________________________ _________________________ _________________________ Have all applicable tax returns been filed? _________________________ Is any governmental agency conducting or planning to conduct an investigation of the Company? _________________________ Has any utility threatened to cut off service to the Company? _________________________ Give a brief description of the Company's business: _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ Does the Company have "petty cash?" _________________________ If so, in what amount? _________________________ Name, address, state, zip, phone number for Company accountant: _________________________ _________________________ _________________________ _________________________ _________________________ |
FAQs
- What does it mean that corporations have "perpetual existence"?
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- How are corporations taxed?
- What type of business organization is appropriate for my business?
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Small Business Center Forms
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