LawCapital Enterprises, LLC

Welcome!

Call toll-free 800-568-8321

No Risk
If you lose your case, you keep the money advanced to you and owe absolutely nothing in return.
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Fast Processing
Once approved, you can typically receive your money within 24-48 hours via overnight mail or direct deposit.
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Competitive Pricing
As every case is different, rates charged will vary with the type of case and may include a monthly fee (2.50-4.99%) until your case settles or a flat fee.
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Plaintiff Application Form Personal Information All Information is Strictly Confidential Must fill out all text boxes or application will not submit. If you don't know the information please enter a question mark! If you do not have a valid e-mail address please use info@lawcapital.net (No credit check is performed. For Identification purposes only.)
* Full Legal Name:
* Address:
* City:
* State:
* Zip:
* Daytime Phone:
Evening Phone:
Fax:
*Email Address:
Date of Birth: (MM/DD/YYYY
Social Security No.

Attorney Information
*Attorney Name:
Firm Name:
Address:
City:
State:
Zip:
*Phone:
Fax:

Case Information
*Type of Case:
Date of Accident: (MM/DD/YYYY
*Location of Accident:
Please Describe Your Case:
*Please Describe Your Injuries:
Please Describe Your Medical Treatment:
Current estimated medical expenses:
Future estimated medical expenses:
Estimated Lost Wages to date:
Estimated Future Lost Wages:
Was a lawsuit filed?
*Amounts loaned/advanced by other companies (if applicable):
Do you currently have an application in progress with another company?
How much money do you need?
Who referred you to us?

Comments:

Release of Information Authorization

Dear,
I hereby authorize and direct your firm to cooperate and release all necessary and requested information and documents pertaining to my current claim or lawsuit which occurred on

to LawCapital Enterprises, LLC its representatives and affiliates.
I understand that all information will be treated as privileged and confidential and will only be used in the limited capacity of underwriting my claim or lawsuit in consideration for a financial advance and will not be further used or disclosed unless so instructed by myself, my counsel or a lawful court order or subpoena. I further understand that LawCapital Enterprises LLC reserves the right to broker fund or co-fund my funding request. Thank you for honoring my request.
Signed:
Date:

Click here for a list of the documents we will need from your case