Secure Attorney Funding Request Form. Advance Lawsuit Funding

Fill out the below, and have ready further documents:
Tax returns for the firm for the last three years
Year-to-date interim income statement and current balance sheet for the firm
A roster of all attorneys in the firm
A list of current cases, including the amount of current case development costs
Declarations page from current malpractice insurance policy
An assignment of life insurance will be required for single owner firms

Name of Firm
Zip/Postal Code
Telephone Number
Fax Number
Primary Contact
How long in practice?
Type of organization - corporation, partnership, sole proprietorship
Federal Taxpayer Identification Number
Number of Partner/Shareholder Attorneys
Number of Paralegals
Number of Associate/Employee Attorneys
Person authorized to execute documents for firm?
Has law firm pledged its accounts receivable to secure any borrowings (yes/no)?
Is the law firm currently involved as a defendent in any lawsuit?
Has the firm ever declared bankruptcy?
Has any partner or shareholder of the firm ever declared bankruptcy?
Has any member of the firm been suspended or disciplined by the state?
Firm's Total Fee Income 2003?
Firm's Total Fee Income 2002?
Firm's Total Fee Income 2001?
Total Case Development Expenses Currently Outstanding - $

Any Comments & Special Instructions. Tell us anything more you want us to know about about your situation.


Double ii's Services/Advance Lawsuit Funding
PO Box 631746
Highlands Ranch CO
Funding Options

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