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Types Of Cases We Fund

Pre-Settlement FundingMotor Vehicle Accident Lawsuit LoansSlip And Fall Accident Lawsuit LoansPedestrian Accident Lawsuit Loans Medical Malpractice Lawsuit Loans Nursing Home Neglect Lawsuit LoansZantac Class Action Lawsuit Loans

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Client Funding Intake Form

Requested Amount:

Client Name:

Client Phone Number:

Attorney Name:

Attorney Phone Number:

Type of Case:Date:Insurance Carrier / “At-Fault” Party:Liability Accepted:Extent of Injuries:Stage of Case:Prior Funding Amount (or “none”):Any other Items to note?

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STATES WE CURRENTLY DO FUND WORKMAN’S COMP CASES:

Florida, Georgia, Louisiana, Missouri, New Mexico, Ohio, Oklahoma, South Carolina

STATES WE CURRENTLY
DO NOT FUND:

Arizona, Arkansas, Colorado, Connecticut, Indiana, Illinois, Kansas, Kentucky, Maine, Maryland, Minnesota, Nebraska, Nevada, North Carolina, Tennessee, Vermont, West Virginia

Mailing Address

505 York Rd
Suite 106
Jenkintown, PA 19046

Telephone

888-322-2400 (p)
215-798-0644 (f)

Email

matt@nationallawsuitfunding.com

State Bar Associations

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Missouri License

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Oklahoma License

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