Johnson Law Firm, P.A.
Free Bankruptcy Evaluation
Contact Info


Please indicate the approximate amount of your debts.

Credit Cards:
Medical Bills:
Student Loans:
Tax Debts:
Personal Loans:
Pay Day Loans:
Other (please explain):


Please indicate approximate amounts for each question below.

Real Estate:
Value: $
Balance: $
Are You Current On Payments?
Motor Vehicle 1:
Value: $
Balance: $
Are You Current On Payments?
Motor Vehicle 2:
Value: $
Balance: $
Are You Current On Payments?

Do you have any other assets worth more than $500?


Briefly describe:


Please tell us about your income.

Full-time Employment:
Part-time Employment:
Child Support:
Social Security:
Pension / Retirement:
Other (please explain):
Approx. Total Monthly Income: $

Contact Information

Please complete all required fields.

Please provide us with your contact information.

*First Name:
*Last Name:
Alternate Phone:
Street Address:
*Zip Code:

*Fields marked with an asterisk are required.

Thanks for your submission

Thank you for submitting your information. Mr. Johnson will be contacting you shortly to discuss what options may be available to assist you with your financial situation. If you do not wish to wait, you may contact him directly by calling (904) 652-2400 or by sending him an e-mail at We look forward to speaking with you.


The hiring of a lawyer is an important decision that should not be based solely on advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

We are a debt relief agency. We help people file for bankruptcy relief under the Bankruptcy Code.