Stone, Higgs & Drexler
Chapter 7 Bankruptcy/Chapter 13 "Wage Earner" Request Form

Date:

Your Company

Company Name
Branch #
Submitted By
Account #

Phone
Address
City
State Zip

Case #
Debtor's Name
Debtor's Attorney
Date of Loan

Other Names
on Account
Date of
First Meeting

Collateral
Who is in Possession of Collateral? You Debtor

Chapter 13 Wage Earner
Chapter 7 Bankruptcy
Original Amount Financed $
Original Amount Financed $
Interest Rate %
Number of Payments Remaining
Payment Amount $
Payment Due Date
Net Balance at Date of Filing (Chapter 13 Wage Earner)
Gross Balance at Date of Filing (Chapter 7 Bankruptcy)
Mortgage Arrearage Amount
Through what month?
Deficiency Balance
Share Account Balance
Stone, Higgs & Drexler file# (if previous file exists)
Comments or Special Instructions

Please include the following:

Bankruptcy Notice
Security Agreement
Contracts

Loan Application
UCC Recording Instrument
Certificate of Title

It is understood that the fee includes the preparation and filing proof of claim, attendance of first meeting of creditors, if in Memphis, evaluation of plan and providing a written report to you. Additional services such as Objection to Confirmation, Motion to Lift Stay, Motion to Amend Plan, Motion of Adequate Protection, Etc., and venues other than Memphis will trigger additional expense.

Stone, Higgs & Drexler Chapter 7 Bankruptcy/Chapter 13 "Wage Earner" Request Form

Your Company

Please include the following:

Stone, Higgs & Drexler
Chapter 7 Bankruptcy/Chapter 13 "Wage Earner" Request Form