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Pre-Lawsuit Form

FREE
CONSULTATION

If you need cash for
your owner financed
residential mortgage
or business note or
wish to discuss your
financial alternatives,
take advantage of our
FREE initial consultation
by calling our offices at
(718) 565-1001
 

Mortgage Notes

Business Notes

Structured Settlements

Lotteries

Senior Life Settlements

Inheritance Advance

Lawsuit Advance

Commercial

 

REQUEST OUR FREE
QUARTERLY
NEWSLETTER
 

                                                  
                 Pre-Lawsuit Advance Request Form

First Name 

Last Name

 

Address 

  Apt / Unit #

 

City 

   State    Zip

 

Phone 

  Fax

 

  Cellular 

E-Mail

 

Victim's Name if other than above.    

 

Case Information

Type of Case You Have

   Auto Related       Construction Related
   Drug Related       Medical Malpractice
   Product Liab.     Workers Comp.
   Wrongful Death  Other
   		 

Date of Event 

   Victim's Occupation

 
              Describe the Nature of Your Case    

 

 
           
      Do You Have an Attorney?    Yes     No     If yes, law firm name
      Your Attorney's Name           Phone
      How Much Money Are You Applying For? ($ Advance)  
      What is the Use of Funds?

   

                                                               


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