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Please complete this quick and easy form to apply for a Lawsuit Cash Advance!

Your Name(required)
Email(valid email required)
AddressAddress, City, State, Zip(required)
Daytime Phone Number(required)
Evening Phone Number(required)
Attorney's Name(required)
Lawfirm(required)
Address of LawfirmAddress, City, State, Zip(required)
Attorney Telephone(required)
Attorney Fax
Attorney Email Address
Classification of Your Injury...
Workman's Comp Personal Injury
Date of Injury/Accident
Describe Your Accident(required)
Describe Your Injuries(required)
Do any of the injuries above pre-exist the accident?
yes no
Are you still under a doctor's care?
yes no
Are you still treating?
yes no
Have medical reports been forwarded to attorney?
yes no
Amount of Cash Advance requested(required)
Do you have any outstanding Child Support?
yes no
If yes, what are they?
How did you hear about American Lawsuit Funding?
Please readTo the best of my knowledge, I do certify that the information provided by me is true and accurate. By click the Submit button I acknowledge and I have read, and agree to all the terms and conditions of the Release and Authorization Form, thereby allowing American Lawsuit Funding LLC to discuss your case with your attorney and any other party involved with your lawsuit.
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