Your strategic partner for legal funding
888-822-7844
For Attorneys & Law Firms
Collateral Request
Law Firms - Collateral
Attorney Information
Attorney Name
Attorney Email
Specific Case Information
Name of Case
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Venue
Docket Number
Type of Case
MVA
S&F
Medical Malpractice
Civil Rights
Employment
Labor Law
Date of Loss/Accident
Defendant Information
Name
Defendant Primary Insurance Company
Defendant Primary Insurance Company Policy Limit
Other Insurance
Underinsured Motorist (UIM)
Uninsured Motorist (UM)
Umbrella
Other Insurance Company
Please write the name of the company
Other Insurance Policy Limits
Retainer Percent
%
Co-Counsel
Yes
If Yes, Split:
Brief case description including liability and plaintiff injuries, next steps in the litigation:
Plaintiff Treatment
Have They Had Treatment
Yes
Brief Description of Treatment to Date
Are They Still Receiving Treatment
Yes
No
If No, When Did They Reach Maximum Medical Improvement (MMI)
Case Value Projection
Demand Amount
$
Estimated Case Value
$
Estimated Gross Attorney Fee
$
Estimated Net to Firm
$
Estimated Duration until Resolution and Disbursement (in Weeks)
weeks
Case Documentation
Retainer Agreement
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Co-Counsel Agreement (if Any)
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Notice of Claim
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Demand
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Complaint
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Answer
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Settlement Agreement
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Court Order on Judgement
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Offer Letter
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Mediation Statement (if Available)
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Police or Incident Report
Photos of Dangerous Conditions (if Applicable)
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Medical Records
Initial Medical Record
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Treatment Summary
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
X-Rays/MRI/Etc.
Drop a file here or click to upload
Choose File
Maximum file size: 52.43MB
Submit
If you are human, leave this field blank.
back to Cartiga
