Double ii's Services/Advance Lawsuit Funding Secure Settlement Funding Request Form.

Fill out what you can, what applies to your case, or what you are comfortable with - even just your contact information is ok if you want us to contact you for details. Or you may simply call 303-220-5679, or Email your name, phone number, and email address, at a minimum. Keep writing in each box - it will scroll forward to take all your information. All information is kept strictly confidential. See requirements and restrictions here. Remember - there is no risk or obligation to you.

First Name
Last Name
Zip/Postal Code
Country - needs to be U.S. or a U.S. territory
Daytime Phone
Evening Phone
Best Time to Call
Email Address
Attorney Name
Name of Attorney's Firm
Attorney Phone Number
Attorney Fax Number
Attorney Address
Who Send Fax To (name of paralegal, for instance)?
What type of case is this (auto, personal injury, etc.)? What happened?
What is the date of the incident?
Is the case settled?
Has the lawsuit been filed yet? When?
Has an offer been made? How much?
Is this in mediation or on schedule for mediation?
Has a demand letter been sent? How much?
Is this out on appeal?
When is it supposed to settle or pay?
What is the case worth?
How much of an advance do you need? Minimum amount.
What are your damages?
What is the amount to be awarded or estimate of settlement?
When is it looking to settle or go to trial?
What is the amount of your medical bills/damages to date?
Have you taken a previous advance? How much? What company?
Do you have liens against this settlement? Please explain.
Are you involved in bankruptcy?
How fast do you need the advance?

Any Comments & Special Instructions. Tell us anything more you want us to know about about your lawsuit or situation.
Your request is via  

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

Chamber of Commerce - on the Web logo