function validEmail(txt)
{
return refind("(^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$)",txt);
}
function trimNonNumbers(txt){
return rereplace(txt,'(\D)', '',"ALL");
}
function isValidPhone(txt){
var stripped = trimNonNumbers(txt);
if (not isNumeric(stripped) OR len(stripped) neq 10)
return false;
return true;
}
Quick Loan Application:
*************** Submittor Information ***************
From: #form.from#, Esq.
RE (applicant): #form.RE#
Full Name: #form.name#
Email Address: #form.email#
Applicant has received a prior advance on this case: #form.q1#
Applicant was under the influence of drugs and/or alcohol at time of incident: #form.q2#
Applicant received Emergency Room treatment: #form.q3#
Applicant suffered soft tissue injury(ies) exclusively: #form.q4#
Applicant aggravated pre-existing injury(ies): #form.q5#
Defendant's insurance carrier has accepted liability : #form.q6#
Defendant's insurance carrier has paid or agreed to pay property damage: #form.q7#
Applicant must overcome Verbal or Limited Tort Threshold : #form.q8#
Is Applicant named in police report: #form.q9#
Was Applicant issued citation in police report: #form.q10#
Was Defendant issued citation in police report: #form.q11#
Was Applicant a passenger: #form.q12#
Number of months of physical treatments received by Applicant: #form.q13#
Property damage to Applicant's vehicle: #form.q14#
Defendant's insurance policy limits: #form.q15#
Applicant's UM policy limits: #form.q16#
Applicant's UIM policy limits: #form.q17#
Applicant's child support / alimony arrearages: #form.q18#
Applicant's gross weekly wage: #form.q19#
Applicant's lost work days: #form.q20#
Amount of Medicare Lien: #form.q21#
Amount of Workers' Comp Lien: #form.q22#
I UNDERSTAND THAT COVERED BRIDGE CAPITAL IS RELYING ON THE ACCURACY OF THE INFORMATION FURNISHED HEREIN. ALL ANSWERS ARE PROVIDED TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF: YesNo
Applicant's Attorney: #form.attorney#
1-Doc Application for Plaintiff's Case Advance at Covered Bridge Capital, LLC
"1-Doc" Application for Plaintiff's
Case Advance
The following form errors have been found:
#errors#
You have successfully submitted your application.
Proud sponsor and Hero Partner of the Pennsylvania Association for Justice (formerly, Pennsylvania Trial Lawyers Association)
