Pre-Settlement Funding Application

ATTORNEY INFORMATION

LAWSUIT INFORMATION

MEDICAL TREATMENT INFORMATION

MONETARY NEED

APPLICANT AGREEMENT

I, the applicant, hereby certify that the answers given above are true, I am 18 years of age or older, and that my injury claim is true and valid. I hereby authorize my attorney mentioned above to fully cooperate with Litigation Funding, LLC, and to allow them to review my file and I further authorize my attorney to answer any questions that may be asked, provide to them copies of my file, and I knowingly waive my attorney-client agreement only to the extent necessary to do so.