funds for cases, lawsuit funding, lawsuit loans, pre settlement funding

Settlement Funding Group, LLC

Funds For Cases Lawsuit Funding

Funding Solutions for Plaintiffs and Attorneys

1-866-242-2659

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Please complete the fields below. All information * are required fields

is strictly confidential. No credit check is required.

First Name: *
Last Name: *
Address Street 1: *
Address Street 2:
City: *
State:
Zip Code: *	(5 digits)
Daytime Phone: *
Evening Phone: *
Cell Phone:
Fax Number::
Date of Birth: *
Email: *
Social Security Number: *
Amount Needed $: *
Date of Accident:
Other Accidents:
Loss of Work:
Time Lost in Days:
PRIOR FUNDING INFORMATION
Prior Funding Amount $:
Prior Funding Company:
ATTORNEY INFORMATION
Attorney Name: *
Firm Name:
Case Manager/Paralegal/Assistant:
Address Street1: *
Address Street2:
City: *
State:
Zip:
Phone: *
Fax Number:
Attorney Email Address:
CASE INFORMATION:
Case Type:
Case Details: *
Extent of Injuries
Driver or Passenger:	Passenger:
	Driver:
Number of People in Vehicle:
I, the undersigned, hereby request and authorize your firm to cooperate and release all necessary and requested information and documents pertaining to my current claim or lawsuit to Settlement Funding Group. I additionally request and instruct you to share your candid opinion(s) regarding my claim or lawsuit with Settlement Funding Group, its' representatives, affiliates and agents. I understand that all information will be treated as privileged and confidential and will only be used in the limited capacity of underwriting my claim in consideration for a financial advance and will not be further used or disclosed unless so instructed by myself, my counsel or a lawful court order.: *

Please email all accident, injury and/or other supporting documents to mail@fundsforcases.com, or fax to Settlement Funding Group, LLC at 704-845-0452