Home Individuals Seniors Attorneys Accountants Financial Planners Real Estate Brokers Small Business Contact Us Fun & Free	Request For Free Appraisal On The Amount of Presettlement Funding You Qualify For (Note: If you are interested in lawsuit financing for purchase of future structured settlement payments Click Here) The items with the YELLOW NAMES are not required but help us serve you better. Please fill out the form to the best of your ability then click on "Submit" below to obtain your free appraisal General Information Name Email Street Address #1 Street Address #2 City State Zip Code Phone Number () Are You Currently Working? Yes No Are You Involved in Bankruptcy? Yes No Size of Advance Desired $ Date You Need Advance Please provide Brief Description of What the advance will be used for   Information On Attorney Attorney Name Attorney Firm Name Attorney Phone Number () Attorney Street Address #1 Attorney Street Address #2 Attorney City Attorney State Attorney Zip Code   Information On Lawsuit Type of Lawsuit Personal Injury (Automobile) Personal Injury (Other) Negligence Sexual Harassment Malpractice Other If "Other", Describe Please provide Brief Description of What Happened Date Incident Occurred Is the Case Settled? Yes No Has the lawsuit been filed? If "Yes", When? Yes  Date No Has an offer been made? If "Yes", How Much? Yes $ How Much? No Is Case in Mediation or On Schedule for Mediation? Yes No Has demand letter been sent? If "Yes", How Much? Yes $ How Much? No Is Case in Appeal by Defendant? Yes No Estimated Time to Settlement?   months How much are your total estimated damages $ Approximate Medical Bills or Damages that have been incurred to date $ What is the Estimate For the total Settlement $ Minimum $20,000 Have you taken any other advances? If "Yes", How Much? Yes $ How Much? No Are there any other liens against this settlement? If "Yes", How Much? Yes $ How Much? No                After your request is submitted, we will try to have a proposal for you within two working days. If you have any questions please call Steve Story at (800) 480-3928 Back to Top...