Lawsuit Funding Application. Get cash advances for your lawsuit settlement.

The Answers you give on this form are for LSFN and its affiliates use only. The information obtained will be used by LSFN only in the analysis and evaluation of your funding request.

Please fill out what you can, some of the questions may not apply to your case, so it is ok to answer only the questions in which you are familiar.

Personal Information

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Home Phone Number:

Other Contact Phone Number:

Email Address:

Attorney Information:

First Name:

Last Name:

Attorney's Firm:

Address:

City:

State:

Zip Code:

Attorney's Phone Number:

Case Information:

Date of Incident:

Describe Your Case:

Describe Damages or Injuries:

Other Information:

Amount of funds being requested:

How did you hear about us?:

DOCUMENT AND INFORMATION RELEASE:
In order to evaluate your request for funding; LSFN will need to obtain certain information and documentation from your attorney. By providing your signature below, you are requesting and authorizing your attorney to cooperate and release to LSFN or its affiliates any and all information and/or documents relating to your claim or lawsuit, including all information in the file that is not protected by the attorney-client and/or work product priviledge. You are further requestion and instructing your attorney to share his/her candid opinions regarding your claim or lawsuit with LSFN, its representatives and affiliates.

If you agree please enter your name in the signature box:

Image Verification:

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