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First Name*:
Middle Name:
Last Name*:
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Email*:
Address 1*:
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Phone 1*:
Phone 2:
Address Type*:	Residential Business
Date of Accident*:
Amount Requested*:
Case Type:	Workers Compensation Personal Injury Lawsuit
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Consent Form

I authorize my attorney to provide Lawsuit Lending with all necessary information pertaining to my case which may include police reports, pleadings, medical information i.e. medical records, medical bills, and insurance coverage. This consent authorizes Lawsuit Lending and its staff to use the information received to process my loan application.

Check here to authorize your attorney to send your case information for evaluation
by Lawsuit Lending.

Submitting this application does not guarantee that Lawsuit Lending will provide you with a loan applied toward your potential settlement. In addition, submitting this information is not a guarantee that the applicant will accept any potential loan offers provided by Lawsuit Lending.