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2017-07-07T03:55:22+00:00
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Plaintiff Application
To get started, fill out the form or call Doubleday at 1-800-577-1676
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Lawsuit Type
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Please Select Case Type
Personal Injury
Auto
Worker's Comp
Medical Malpractice
Premises Negligence
Wrongful Death
Other
State the accident/injury occurred?
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Neveda
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
Has a lawsuit been filed?
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Please Select Yes or No
Yes
No
Has a demand been filed?
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Please Select Yes or No
Yes
No
Has the insurance company offered a settlement?
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Please Select Yes or No
Yes
No
What was the amount?
Have you received previous funding?
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Please Select Yes or No
Yes
No
Date loan taken
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DD
YYYY
I hereby authorize my attorney to provide Doubleday Funding, LLC with all information, oral or written pertaining to my action. I understand that it is imperative that all information shared is honest and forthcoming in order to properly evaluate my requested funding.
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Yes
No
By submitting this form, I agree that all the information listed is accurate and correct. In order to obtain information about your case, we need your authorization for your attorney to release your case file and other information regarding your case. We cannot proceed without such authorization. In doing so I am agreeing to waive my attorney client privilege and hereby acknowledge and understand the risks and benefits of non-recourse funding.
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You have read the terms and conditions and accept them.
Yes