Attorney Application

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.

Application for Attorneys

Attorney's Name: *

Co-Counsel:

Address: *

City: *

State: *

Zip Code: *

Attorney's E-mail: *

Attorney's Phone:

Attorney's Fax:

Client's Name:

Nature of Incident: *

Date of Incident:

Proof of Liability:

YesNo

Medical Specials:

Future Medical Specials:

Amount of Liens:

Lawsuit Filed?:

YesNo

(If Yes) When?:

(If Yes) Case No.:

Where?: (County)

Lawsuit Answered?:

YesNo

(If Yes) When?:

Estimated Case Value: *

Insurance Carrier:

Claim: *

Policy Limit:

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

YesNo

If Yes, Please Identify Such:

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

Yes

Date:

State Bar No:

or Reset

Call us toll free at:

877.386.3548

We're more than just a lending source!

We refer cases to your firm.
We connect your firm with other firms to co-counsel.
We help you develop new business relationships.
We assist in marketing your firm nationwide.
We can create facilities for most corporate finance projects.

NLF Inc., Corporate Finance Division 79-405 Hwy 111, Suite 9-285, La Quinta, CA 92253 – Phone: 1-760-777-8585
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Attorney Application

Application for Attorneys

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We're more than just a lending source!

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