Client Application

Once approved, we provide the money you need quickly to protect your way of life while awaiting the outcome of your trial.

Step 1 - Tell us about your claim.

Step 2 - Tell us about your attorney.

Step 3 - Tell us about your case.

Type of Case:
Date of Accident:
Pre-Settlement Funding Request:
Describe What Happened:
Location of incident: (city, county)
Describe your injury:
Did you go to the hospital in an ambulance?
If not, when did you go?
Were you admitted to the hospital?
How long did you stay?
Were you in intensive care?
Did you require surgery?
Total hospital bills:
Total medical bills:
Total lost wages:
Have you ever been bankrupt?
Have you accepted any other pres-settlement funding for this case? If so, please describe the amount due.

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