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National Lawsuit Funding prefers discussing case details on the phone so we can truly feel out the case.
But, this day in age, a lot of attorney's request a written form.
Try to be as candid and detailed as possible.
Client Info
*
Indicates required field
Client Name
*
First
Last
Client Phone Number
*
Attorney Info
Attorney Name
*
First
Last
Attorney Phone Number
*
Attorney Email
*
Case Details
Type of Case
*
Auto
S&F
W/C
Med Mal
Other
Date of Accident
*
At Fault Liability Carrier
*
Claim #
*
Liability Carrier's Adjuster's Name & Phone Number
*
Policy Limit's (if known)
*
Liability Accepted?
*
Yes
No
Undetermined
Soft Tissue Injuries
*
Yes
No
List surgery/injections/etc if more than soft tissue
*
Total of Meds (if known)? (an estimate is ok)
*
Prior Fundings?
*
Yes
No
Not sure
If there are prior fundings, how much and from whom?
*
BRIEFLY Describe Accident
*
What Else Would you Like us to know about the case/client?
*
Submit
Home
Process
Contact
Questions
Apply
888-322-2400
