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How to qualify

For fast approval of a legal cash advance, please complete the short application below.

Funding Information
Amount Requested:
Prior Funding Amount:
Funding Company:
 
Claimant Information
Name:
E-mail:
Home Telephone:
Cell/Mobile Telephone:
Work Telephone:
Address:
City:
State:
Zip Code:
 
Attorney Information
Law Firm:
Attorney Name:
Telephone Number:
E-mail:
Address:
City:
State:
 
Incident Information
Date of Incident:
State:
Type of Accident:
Describe Incident/Accident:
Injuries:

In order to obtain information about your case, we need your authorization to release your case records and information to us. We cannot proceed without it.

Enter your ATTORNEY’S NAME here:

I request and authorize that my attorney to provide Nirvana Legal 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 Nirvana Legal any and all information and documents pertaining to my case. Please share your candid opinion regarding this action with Nirvana Legal so that Nirvana Legal and their underwriter 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.

Thank you in advance for your cooperation.

Name:
Date:

By checking this box, you indicate that you have read and agree to the Records Release Authorization. You must check this box for your application to be processed. This authorization gives us permission to contact your attorney and discuss your case with your attorney. By submitting this form I agree that all the information listed is accurate to the best of my knowledge.