Home
Funding
Apply Now
FAQ
Terms and Conditions
About Us
Contact Us
 

Florida Legal Funding, LLC

* Required Fields

Personal Information

* Last Name
* First Name
* Date of Birth
* Social Security Number
* Address(number, city, state, zip)
E-mail
* Phone Number
Are you currenly in bankruptcy?Yes    No
Do you presently intend to file for bankruptcy?Yes    No

Attorney Information

* Attorney Name
* Law Firm Name
Address(number, city, state, zip)
Phone Number
Fax Number

Case Information

* Type of Case

(If selected "Other," then specify)

* State that claim is being made in
* Date of Injury
* Place of Injury(City and State)
* Type of Injury
Is the defendant in bankruptcy?Yes    No
Have you changed attorneys in the past?Yes    No
Have you obtained a prior advance on this case?Yes    No
Have you issued a Letter of Protection to any health care providers?Yes    No
* Amount of Funding requested$
I am requesting funds to cover basic necessitiesYes    No

How did you hear about us?

Search Engine Attorney Referal Direct Mail Other

Certification

The information provided in this application is true, accurate, and complete, to the best of my knowledge and belief.

I hereby authorize my attorney to release documents to Florida Legal Funding to aid in determining whether my case is appropriate for legal funding.
Yes No

I hereby authorize Florida Legal Funding to conduct credit verification .
Yes No
Name
Date
* Submission of this application does not guarantee funding.


    
Home| Funding| Apply Now| FAQ| Terms and Conditions| About Us| Contact Us

Florida Legal Funding, LLC
PO Box 163
Winter Haven, FL 33882

Toll free: 1-800-380-1431
Fax: 1-813-682-2676
e-mail: info@floridalegalfunding.com

 

© 2005 Florida Legal Funding, LLC. Winter Haven, Florida, USA. All rights reserved.

This website and all the information it contains, or may in the future contain, are the property of Florida Legal Funding. Florida Legal Funding claims a copyright in all proprietary and copyrightable text, graphics, and computer code on this site, overall site design, and the presentation, selection, and arrangement of all information on this site, including information in the public domain.