Business or Consumer Debtor Analysis Form

Complete the following Business or Consumer Debtor Analysis Form (BCD Form) and submit it to the Law Office of Jon B. Clarke when you are ready to learn more about your best debt relief options. You can submit the BCD Form via email or fax (303-850-7115). Remember, email is not secure; there is a slight possibility that the information you send could be viewed by others.

Information Collection and Use

The Law Office of Jon B. Clarke is the sole owner of the information collected via this site. This firm alone will have access the information that you have voluntarily provided us via email or other direct contact.

This firm will not sell or rent your information. Your information will only be used to respond to you regarding your debt concerns or issues. The Law Office of Jon B. Clarke will not share your information with any third party outside of our organization, other than as is necessary to resolve your debt issues.


This website contains links to other sites. Please be aware that the Law Office of Jon B. Clarke is not responsible for the content or privacy practices of other sites. We encourage you to read the privacy statements of any other site that collects your personal information.

Please also be aware that confidential or time-sensitive information should not be sent via this email link. If your situation is urgent, please call (303) 779-0600.  If available, Colorado Springs Bankruptcy Attorney Jon B. Clarke will take your call. If not, briefly explain your situation to his receptionist or legal assistant, or leave a voicemail. As you await a response, please complete the form below and fax or email it to us.


*Name of prospective client (the "debtor"):

The prospective client is: (check all that apply)

Individual(s) with only consumer debts

Individual(s) with both business and consumer debts

Owner of a sole proprietorship business

General partnership

Limited partnership

Limited liability company

S corporation

C corporation

Owner of Income Property - Residential

Owner of Income Property - Commercial

Does the debtor own real estate?


ResidenceSecond residenceTimeshare unitRental Home(s)

Office buildingIndustrial/Warehouse buildingRaw land

Primary residence real estate market value: $
Primary residence First mortgage payoff amount/Monthly Payment $
Primary residence Junior mortgage payoff amount/Monthly Payment $
Secondary residence real estate market value: $
Secondary residence First mortgage payoff amount/Monthly Payment $
Secondary residence Junior mortgage payoff amount/Monthly Payment $
Combined Rental Houses market value: $
Combined Rental Houses mortgage payoff amount $
Combined Rental Houses monthly profit $
Combined Rental Houses monthly loss $
Is the debtor a tenant in rental real estate? YesNo


Monthly rent payment: $
Rent arrearage, if any: $
Months left on the lease: $

Business Personal Property (supply estimated liquidation value)

Furniture, fixtures, equipment, inventory, accts receivable value: $
Seller-carried loan balance: $
Bank/SBA loan balance: $

Consumer Personal Property
(use current replacement/retail value)

Value of all vehicles: $
Value of other personal property: $
Vehicle loan or lease payoff total: $
Personal property loan or lease payoff total: $

The Priority Debts Debtor Owes:

Employee Wages: $
Customer Deposits or pre-payments: $
Payroll Taxes: $
Sales & Unemployment Taxes: $
Income Taxes: $
Last year for which a federal income tax return was filed:
Wage income on this return $
Business (schedule C, E) income/loss on this return: $

Unsecured Debt Balances:

Credit Cards - Consumer use: $
Credit Cards - Business use: $
Other Consumer Debts (Medical, Student loan): $
Business Trade Creditors and Vendor Debts: $
Permanently-guaranteed business trade Creditor/Vendor Debts: $

Name of Person to Contact?:

How should we contact you? (more than one can be checked)

By email at the sender's email address:
At home telephone:
At work telephone:
On a cell phone:
Best time to contact you:

Why do you need our help?

DISCLAIMER: The information you have obtained from this website is not, nor is it intended to be, what is commonly called "legal advice". Pursuant to the 2005 Act, this firm must determine your status as a business or consumer debtor and provide certain disclosures and notices before it can give meaningful, personalized "legal advice" to any individual or business entity.