‹ Return Home
Step
1
of
9
11%
Hi there! Thanks for using InjuryWallet. Your answers to these questions will help us
find the lowest possible rate
for your settlement advance. Let's get started.
This form normally takes folks less than 2 minutes to complete.
How much money
do you need?
Enter Amount
In
which state
did your incident occur?
(
NOTE:
Unfortunately, we are
not
able to help you secure funding if your lawsuit is in Arizona, Arkansas, Colorado, Illinois, Indiana, Maryland, Minnesota, Nevada, South Carolina, Tennessee, or West Virginia 😔 .)
Unfortunately,
we are not legally able to provide pre-settlement funding to plaintiffs in your state
, nor are we able to refer you to another company who can. We are sorry for the inconvenience.
State
(Required)
Select Your State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
On
what date
did your incident occur?
Date of Loss
Don't Remember
I don't remember the date of loss
What
type of case
do you have?
Type of Case
Motor Vehicle Accident
Slip/Trip & Fall
Premises Liability
Settled Case
Medical Malpractice
Product Liability
Wrongful Termination
Labor Law
Sexual Abuse/Harassment
Other
What
type of treatments
have you received?
(Select all that apply)
Type of Treatment
Chiropractor
Injections
MRI
Surgery
Physical Therapy
Recommended for Surgery
Recommended for Injections
Other
Not Applicable
Can you please
describe your case?
(This helps us understand more about the nature of your case, which allows us to secure funding faster.)
Case Description
Have you received a
prior cash advance on this case
from another company?
(This is optional, but this information will help us find a funder who's most likely to be able to help you.)
Have They Already Received Funding?
Yes
No
Almost done! Just a couple more things...
What’s
your name
and how can we
contact
you?
First Name
(Required)
Last Name
(Required)
Email Address
(Required)
Phone Number
(Required)
You are done right after this screen!
We need your
lawyer’s information
(We make it easy for them to confirm the details of your case so we can quickly find you funding at the lowest possible rate.)
Attorney First Name
Attorney Last Name
Law Firm Phone Number
Law Firm Email
Unknown Attorney Info
I can't recall my lawyer's name right now
Δ
