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First Name


Email


In which state did your accident happen?


What was the nature of your accident?


Last Name


Phone


Are you represented by an attorney?


Amount requested


Feel free to leave any questions or concerns here:

Terms and conditions I request and authorize my attorney to provide Arthur Funding with whatever information (whether oral or in writing) needed to evaluate my funding request. I specifically waive any privilege that I may have regarding such information.

I hereby request and authorize your firm to cooperate with and release to Arthur Funding any and all information and documents pertaining to my case. Please share your candid opinion regarding this action with Arthur Funding, so that Arthur Funding can evaluate my funding request.

I acknowledge that I understand the benefits and risks of non-recourse funding. I further acknowledge that I understand the effects of disclosing the contents of my file, including waiver of the attorney-client and work product privileges and HIPAA privacy (to release medical records).

You must check the box for your application to be processed. This authorization gives us permission to contact and discuss your case with your attorney and for the law firm to provide the requested documents.

By submitting this form, I agree all the information listed is accurate to the best of my knowledge.

First Name


Last Name


Email


Phone


In which state did your accident happen?


Are you represented by an attorney?


What was the nature of your accident?


Amount requested


Feel free to leave any questions or concerns here:

Contact

(888) 830-2959

E-mail: intake1@arthurfunding.com

Corporate Headquarters

210 Sylvan Avenue

Englewood Cliffs, NJ 07632