personal injury, pre-suit, accident case, litigation, financing, funding, emergency money, lawsuits, claims, negligence, non-recourse advances, clients Online Application
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Personal Information
Name
Address
City
State
Zip Code
Phone Number
 
E-Mail address
Lawyer's Information
Firm Name
Lawyer's Name
Address
City
State
Zip
Phone Number
 
Fax Number
 
Email Address
Case Information
Date of Incident
     (MM/DD/YYYY)
Lawsuit Filed
Describe Incident
Describe Injuries
How much are you
requesting as an Advance?
Authorization for Release of Information
Dear ,
I hereby authorize and direct you to release to a representative of Fastfunds4u.com, any portion of my file related to your representation of me, for injuries sustained in the incident of,
I acknowledge that I understand the benefits and detriments of non-recourse funding. I further acknowledge I understand the effects of disclosing the contents of my file, including waiver of the attorney-client and work product privileges.
Thank you in advance for your anticipated cooperation, I remain,
Full Name
Date     (MM/DD/YYYY)
All Information Is Strictly Confidential