Judgment Intake Form

Your Name (Judgment Creditor (JC):*
Your Address:
Street Address Address Line 2 City State ZIP Code
Your Daytime Phone:
Your Evening Phone:
Your Email:
Name of attorney you used:
Case Number:
Date of Judgment:
MM slash DD slash YYYY
Sued in the County Of:
Awarded in the State of:
If Docketed (recorded as a Lien) enter JD #:
Judgment Amount:
Amount Collected to Date:
Did you win by Default?:
- Yes
- No
Judgment Debtor Name (JD):
JD Address:
Street Address Address Line 2 City State ZIP Code
JD Phone:
JD Social Security No:
Debtor's Job:
Debtor's Assets:
Other Debtor Information:
Comments or case description:
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