Attorney and Law Firm Funding Loan Application

get lawsuit loan - cash for your lawsuit in 7 days or less

ATTORNEY FUNDING APPLICATION

Instructions: Please complete this application to the best of your ability. If you do not know the answer to a question, just move on. We can obtain the answers from you at a later time. It is more important to get the application submitted to us than to worry about each specific question. If you have any questions please contact us.

Please note that all fields followed by an asterisk must be filled in.

First Name*

First Name*

Last Name*

Last Name*

E-mail Address

Web Site URL

Street Address

City

State/Prov

Zip/Postal Code

Business Phone*

Business Phone*

Fax

Social Security Number

Date of Birth

Federal Tax Payer ID

Amount of Funding Requested

Funding Product(s) of Interest

	Plaintiff Funding
	Medical Funding
	Expert Funding
	Appeal Funding
	Attorney Funding
	Credit Line (Revolving)
	Law Firm Loan (Term)
	Other

Number of cases you will be submitting as collateral

Year Admitted to Bar

States Licensed in

License Number

Have you or the firm ever filed Bankruptcy?

	Yes
	No

If yes, date of filing

If yes, date of discharge

Does the firm have any outstanding debt/lines of credit?

	Yes
	No

If yes, has a UCC been filed

	Yes
	No

If yes, source of debt / credit

If yes, amount of debt / credit

Does the firm have any outstanding cash advances

	Yes
	No

If yes, source of advance

If yes, amount of advance

Any pending claims / existing judgments against the firm

	Yes
	No

If yes, explain

Does the firm maintain malpractice insurance

	Yes
	No

If yes, insurance company

If yes, coverage limits

Policy Number

Have you ever taken an advance against your contingency fees before

	Yes
	No

If yes, with which funding company

This application is also available via: phone, fax, email, and even traditional mail. Please contact us if you wish to complete the application other than online.

Note: There is also some requested information on the above application that we will need if we are to close a funding for you. This includes your date of birth, social security number, and your firm's Federal Taxpayer ID (EID), if your firm is a separate entity. We will use this information to run your credit (both personal and business), but only after we arrange permission in writing first. After submitting your funding request, we will be contacting you to arrange for permission to pull your credit and to request the case documents for the cases you plan on submitting for funding consideration.

* See our Lawsuit Loan Disclaimers & Clarifications

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