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Quick Advance Application

 

"1-Doc" Application for Plaintiff's Case Advance

 

  The following application must be completed by Attorney.

 

 
  Kindly fax or email a copy of the police report.

Fax:    (215) 646-9701

Email: info@covbridgecap.com

 

 

From: , Esq.
RE (Applicant):
Full Name:
Email Address:

 

Your client, the above referenced Applicant, has contacted us seeking a “lawsuit loan”. This questionnaire is intended to accelerate the approval process for non-major cases. Answers provided below will be relied upon in rendering an instant approval or rejection of Applicant’s request. Please remember to include police report if available. Thank you.

 

Yes No  

Applicant has received a prior advance on this case

Applicant was under the influence of drugs and/or alcohol at time of incident

Applicant received Emergency Room treatment
Applicant suffered soft tissue injury(ies) exclusively

Applicant aggravated pre-existing injury(ies)

Defendant’s insurance carrier has accepted liability                       

Defendant’s insurance carrier has paid or agreed to pay property damage

Applicant must overcome Verbal or Limited Tort Threshold     

Is Applicant named in police report

Was Applicant issued citation in police report

Was Defendant issued citation in police report

Was Applicant a passenger

Number of months of physical treatments received by Applicant
Property damage to Applicant's vehicle
Defendant’s insurance policy limits
Applicant’s UM policy limits
Applicant’s UIM policy limits
Applicant’s child support / alimony arrearages
Applicant’s gross weekly wage
Applicant’s lost work days
Amount of Medicare Lien
Amount of Workers’ Comp Lien

 

 

 
  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.
  Applicant's  Attorney:
 

 

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