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General Bankruptcy Information Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Mailing address
*
Your answer
Do you have any other names/alias that you are known by?
Your answer
Phone number
*
Your answer
Marital Status
*
Single (never married)
Separated (but not divorced)
Married
Single (Divorced)
If married, please provide spouse's name
Your answer
Who is your employer?
Your answer
Do you have debts with ACNB bank?
Yes
No
Maybe
Clear selection
Do you own a business? If so, what is the name?
Your answer
If you own a business, state below the full legal name of the business, and describe the extent of your ownership. Please also name any other co-owners of the business.
Your answer
Do you have dependent children (under 18 or still in school)? State how many, if whether they reside with you, and their ages.
Your answer
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