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    Online Attorney Questionnaire

    Date: Client:
    Attorney:
    D/A: Type of Case:
    In Suit?  Yes No
    Mediation Date: Award:
    Plaintiff:  Accept Reject Defendant:  Accept Reject
    Demand Amount: Offer Amount:
    Case Value (opinion):
    Settlement Prospects:  Good Fair Poor
    Settlement Expected:  Within 30 days 30-90 days 90-120 days Other
    Trial Date:
    Liability (Strengths/Weaknesses):
    Injuries:
    Prior Injuries:
    Insurance Co: Claim #:
    Adjuster\'s Name: Policy Limit:
    Address:
    Phone: Fax:
    Defense Attorney: Case #:
    Address:
    Phone: Fax:
    Attorney Fee: Litigation Cost:
    Medical Liens: Other Liens:
    Previous Lawsuit Funding Company:
    Amount: Payback:
    Additional Comments:

    Litigation Funding

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  • Attorney Advance Form
  • Attorney Questionaire
  • New Funding Intake Form
  • Structured Settlement Payments Worksheet
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  • Downloadable Forms
  • Frequently Asked Questions
  • Litigation Funding Resources
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    Southfield, MI 48034
    248.948.1800

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