Litigation Funding

Lawsuit Settled Case Funding - Full Application

Your Contact Information

*First Name:

*Last Name:

Address:

City:

State:

Zip:

 

*Cash Advance Amount Requested (Min $1,000):

Work Phone:

Home Phone:

Cell Phone:

*Email:

Have you taken any other loans against your settlement?

 

If yes, what is the approximate current payoff amount?

 

Attorney Contact Information

Attorney Name:

Attorney Address 1:

Attorney Address 2:

Attorney City:

Attorney State:

Attorney Zip:

 

Name of Law Firm:

Attorney Phone:

Attorney Fax:

Paralegal Name:

 

Comments or Questions:

Lawsuit Description

Type of Case:

 

Date of Incident (mm/dd/yyyy):

Please Describe Incident:

Please Describe Injuries / Damages: For personal injuries, describe strains, sprains, surgeries, fractures, etc.