Apply for lawsuit loan : Preferred Capital Lending


Please complete the form below to submit your application. (fields marked with an * are required)
First Name* :
Middle Name:
Last Name* :
SS#* :
Email:

Address 1* :
Address 2:
City* :
State* :
Zip Code* :
Phone 1* :
Phone 2:
Address Type* :

Case Type* :

Amount Requested* :	($xxx.xx)

Attorney's Name* :
Date of Accident* :	(mm/dd/yy)
Accident Information:
	How did you hear about the company? Attorney Television Radio Internet Brochure Friend DirectMail Other I hereby authorize my attorney, __________, to release to Preferred Capital Lending any and all non-privileged information in my case file including but not limited to all police reports, pleadings, medical records, itemizations of medical bills and insurance coverage information. By doing so I further give Preferred Capital Lending and its staff authorization to use the information received to review and process my loan request. Check here if you authorize and instruct your attorney to forward your case information to Preferred Capital for evaluation upon request.

	Submission of this application is not a guarantee that Preferred Capital Lending will provide the applicant with a loan against the potential settlement. Submission of this application is not a guarantee the applicant will accept any potential loan offer made by Preferred Capital Lending. SUBMIT APPLICATION Home \| Clients \| FAQs \| Privacy Policy \| Ethics Opinions \| Contact Us \| Site Map