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Charter Club:
Plaintiff
Funding
Please complete the form below by providing your client's information for their funding application.
Charter Club Application
State of Residence
*
-
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Cartiga does not provide funding in your plaintiff's state
First Name
*
Last Name
*
Email Address
*
Date of Birth
*
Accident Type
*
Motor Vehicle Accident
Premises Liability
General Negligence
Labor Law
Medical Malpractice
Civil Rights
Settled Case
Sexual Assault
Wrongful Death
Wrongful Termination
Victims Compensation Fund
Other
Social Security Number
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Phone Number
Approved Funding Amount
*
$
If you are human, leave this field blank.
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