Contact Us

If you a attorney or law practice seeking funding for their cases then please fill out the Attorney Application form below. We review every application we receive and if you qualify our team will contact you shortly. We look forward to hearing from you soon.

Attorney's Name:*

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Co-Counsel:*

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Address:*

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City:*

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State:*

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Zipcode:*

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Attorney's Email:*

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Attorney's Phone:*

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Attorney's Fax

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Client's Name:

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Nature of Incident:

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Date of Incident:

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Proof of Liability:

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Medical Specials:

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Future Medical Specials:

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Amount of Liens:

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Lawsuit Filed?:

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(If Yes) When?:

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Estimated Case Value:

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Insurance Carrier:

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Claim:

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Policy Limit:

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Are any of the parties or their insurance carriers in Bankruptcy, Receivership or Liquidation?:

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If Yes, Please Identify Such:

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I promise that the information provided regarding said lawsuit is truthful and complete to the best of my knowledge. :

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State Bar No:

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Requested Amount For Your Loan:*

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Cases Handled

West Coast Location

East Coast Location