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Multi Funding USA is dedicated to providing Attorneys and their staff with obsessive supreme customer service.

For your convenience, we are providing an instructional video and step-by-step instructions for completing our online Attorney Intake Form.

Click here to watch the video:

 

For returning attorneys, please enter your email address and click continue. If you have used our form before, we will fill in some of your information for you.
 

CONTINUE
 

Information: Please Attach, Fax or Email the following information with the Intake Form

1. MRI´s or other medical records showing injuries
2. Police report
3. Bill of particulars or copy of complaint.
4. Record of prior accidents or injuries
5. Pictures of defect


Fax: 866-957-8880

Click on the "Browse" button below to conveniently attach the required files within your computer. Click "Add" to add more files. Click "Remove" to remove files. Once the Attorney Intake Form is complete and the "Submit" button is clicked, your files will forward along with the Attorney Intake Form.

Attach File

 
 
Requested Funding Amount $:
Client Name: ST:
Client Address: Zip Code:
City: Client Telephone:
Client Date of Birth: Client Mobile No:
Client Social Security No: Client Email:
Case Information:Missing data will delay processing  
Type of Case: Fractures/Broken Bones?:
If Auto Case, Passenger or Driver: Surgery?:
Date of Incident: MRI?:
Insurance Carrier: Prior Accidents and/or Injuries:
Policy Limit: If case is in suit: Court/County:
Previous lien on this case: Index Number:
If Yes, Amount: $: Case Name:
Company: If not in suit: Defendant(s) names:
Pending child support liens: Yes No    
 
Attorney Name: Please tell us how you were referred to Multi Funding
Law Firm: Online Search  
Address: Postcard  
Phone Number: Brochure  
Fax Number: I am a current client  
Attorney Email: Directed to visit website by
      Multi Funding Representative
Paralegal/Alternate Contact Name: Referred by:
Paralegal/Alternate Contact Email Address: Other, please explain:
Additional Information:      
     
   
         

If you prefer to fax the Intake Form, please download below and fax with items listed above. Fax: 866-957-8880

 
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