Plaintiff Funding Application
Name
Street Address
City, State and Zip Code
Phone Number
Fax Number
Cell Number
Email Address
What is the best time to reach you?
Is your Attorney on a Contingency?
True
False
What %?
Has a Demand Letter been sent?
True
False
Has your Lawsuit been filed?
True
False
Has Liability Been Admitted?
True
False
What is the Amount Requested?
Please provide additional details you want to share on your case:
Signature
Date
I authorize my attorney to disclose any and all information related to my case to Lake Tahoe Financial for purposes of funding.
= Required
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