Settlement Advance Application

Please submit the following settlement funding information to be enrolled in our settlement advance program.

    Attorney Information

    Patient Information

    At Fault Party

    I hereby request and authorize Beacon Legal Funding to contact my attorney to obtain relevant case information and/or records for purposes of evaluating my settlement advance request while understanding that these parties are subject to strict confidentiality. I request and authorize my attorney to cooperate with and release to Beacon Legal Funding any and all information pertaining to my case, including candid opinions regarding this action.

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