LAWSUIT LOAN | LAWSUIT FUNDING FORM
To help us best serve your needs, please fill out the following Lawsuit Loans | Lawsuit Funding Form. Fields marked by "*" are required.


NOTE: We will never, ever, ever give away or sell your information. It is completely safe with us. We hate SPAM as much as you do and we will never send your correspondence other than what is necessary to complete a funding request.


Full Name:*

Street Address:*

City, State:*

Zip Code:*

Telephone Number:*

Email Address:*

How much are you suing for?*

How much money has your attorney told you your case is worth if successful, excluding chiropractor bills?

How much money do you need now?*

Why do you need cash at this time?*

Type of Case:*
Auto      
Personal Injury      
Worker's Comp      
Sell Structured Settlement      
Wrongful Death      
Commercial      
Other

Briefly describe your case:*

If a trial date has been set for your case, please list the date here:

What damages have you suffered? Did you have, or do you require surgery?*

On what date(s) did this incident occur or damages were suffered?*

On what date was your lawsuit filed?*

Have you received a settlement offer or agreed to a settlement?
No      
Received Offer      
Agreed To Settlement      

How much is the offer/settlement for?

Are you 18 years or older?
Yes      
No      

Are you currently in bankruptcy?
No      
Yes      

Have you already gotten funding for this case?
No      
Yes      

If you have already gotten funding for this case, please explain how much, from whom and when:

Attorney Name:*

Attorney's Business Address: Street, City, State, Zip:*

Attorney Phone Number:*

Attorney Fax Number (if known):

May we contact your attorney?*
Yes      
No      

Privacy Policy
We will never, ever, ever give away or sell your information. It is completely safe with us. We hate SPAM as much as you do and we will never send your correspondence other than what is necessary to complete a funding request.


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