Do you have a legal case pending which is likely to award you a monetary sum? In some cases, it may be difficult for you to make ends meet until your case works its way through the legal system and your monetary reward is secured. Many people find themselves in a situation where they are forced to accept a settlement which is much lower than they deserve in order to pay off medical expenses and other bills. If this is happening to you, we can help!

1 . First Name *

2 . Last Name *

3 . Email Address *

4 . Telephone Number

5 . Are you personally receiving payments on this note? *
Yes No

6 . Name of attorney representing you (required) *

7 . Telephone number of attorney representing you (required) *

8 . Address of attorney representing you (required) *

9 . Please describe in detail that facts and circumstances surrounding your case. Be as complete as possible. (required) *

10 . Have you received any offers from the party/business involved or the insurance company representing them? (required) *

11 . If yes, please describe offer.

12 . What amount of money do you hope to receive in this pre-settlement purchase? (required) *

13 . What was the date of the original injury or event? (required) *

14 . Is there a court date scheduled at this time? (required) *
Yes No

15 . If yes, please list scheduled date.

16 . Please tell us about your needs and expectations so that we may better serve you. (required) *