Thank You

Your Lawsuit Funding Request Has Successfully
Been Submitted!

All completed applications are forwarded to our processing
department for review and a request for your case information will be faxed to
your attorney within 1 business day.  If additional information is
needed, we may contact you for further details.


VERY IMPORTANT!

Please notify your attorney
immediately that you have applied for an advance on your
settlement and that you authorize and instruct them to release any information
that we may request.  We cannot process your application without your
attorney’s cooperation.

You should receive a response from our funding department
within 3 business days after we receive the requested documents from your
attorney.

Feel free to contact us at 1-877-721-2274 with any further questions.

We appreciate the opportunity to assist
you with your financial needs!

*If you have accidentally submitted
an incomplete application, click the back button on your browser above.



Apply for Lawsuit Funding

To apply for lawsuit funding, please complete the form below, and we will process your request immediately.

Applicant Name *

Phone #1 *
- -
Email address *

Date of Birth (mm/dd/yyyy) *

Postal Address *

City *

State *
Type of Case *

Have you Received Previous Advance? *
Yes     No
if Yes how Much?

Attorney Name *

Attorney Phone Number *
- -
Attorney Fax
- -
Attorney Email

How much money do you need? *
Describe the Incident? *
Describe the Injuries Sustained? *


I have read and agree to the terms of the Authorization to Release Information