Pre-Legal Settlement Advance Quotation Form
Your Name:
Your Email Address:
Your Contact Phone:
Contact Fax:
Victim's (Plaintiff's) Name:
Lawsuit / Case Information Worksheet
Type of case you have?
Victim's Occupation:
Date of Event:
Is the Plaintiff able to work?
Name of Attorney:
Attorney's Email:
Attorney's Phone:
Name of Law Firm:
Describe the nature of your case,
the amount of funds requested,
and why you are seeking

If you are receiving payments and would prefer to have a lump sum of cash now, please call us today toll-free at 1-877-462-4055 to obtain a free no obligation evaluation of your note or payment stream. If you prefer, you may also submit a confidential quote request by email.
We look forward to hearing from you and helping you free up the cash you want or need now.