Litigation Funding

Lawsuit Settled Case Funding - Full Application

Your Contact Information

*First Name:

*Last Name:






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

Work Phone:

Home Phone:

Cell Phone:


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.