Second Form

Second Form

  • APPLICATION

  • All information provided is confidential. By executing this document, you certify and acknowledge that the information provided herein is true, correct, complete and accurate as of the date signed below. You further acknowledge that our underwriters will rely on the information provided herein as part of a decision regarding whether credit will be made available to your law firm. If any of the information provided below changes during the underwriting and due diligence process, prompt notice must be given. Until such notice is given, we may rely on the information herein.


    1. Please list the dollar amount of capital requested and provide a brief explanation for the use of the capital.

  • Please provide the following information for every equity partner in your law firm:

  • Please list the following for each equity partner in your law firm:

  • Please list the following information for each equity partner in your law firm:

  • Please list the following personal financial information for each equity partner in the firm:

  • Please list the following for every entity that you have ownership and/or control of that collects attorney’s fees:

  • Please list the following information regarding your law firm:

  • Please list the following financial information regarding your law firm:

  • Please list the quantity and type of cases currently on your docket (e.g., automobile accident-15, slip and fall-10, dog bite-5, premise liability-13, class action-15, etc.)

  • Please list the following information for your law firm:

  • By executing this document below, the undersigned certifies and acknowledges that the information provided herein is true, correct, complete and accurate. Further, the undersigned acknowledges that our underwriters will rely on information provided herein as part of a decision regarding whether credit will be made available to your firm.

  • Acknowledgement & Agreement

  • As part of the application process, you understand that we may request a credit report or an investigative consumer report about you. You understand that the nature and scope of this investigation may include information from public and private sources concerning ,among other things, your driving record, civil and criminal court records, credit, education history, credentials, identity, past addresses, social security number, previous employment, and personal references. You understand that your consent will apply throuhout the time you do business with us and that we or our afiliates are allowed to periodically run credit reports as we deem necessary in our sole and absolute discretion. The Undersigned (I/We) herewith submit the attached financial and supporting schedules which constitute my (our) financial statement.This statement is submitted to you for the purpose od inducing you to extend or maintan credit to me (us). I (we) certify that the attached Application and any financial statements present a true, complete, and correct statement of my (our) financial condition as of the date shown and does not omit any pertinent information. I (we) understand that misrepresenting information on the attached statement is a criminal offensive under federal law. I (we) will notify you promptly in writing of any material unfavorable change in my (our) financial condition. In the absence of such notice, you may consider this a continuing statement and substainly correct. If I (we) apply for the further credit, this statement shall have the same force and effect as if delivered as on original statement of my (our)financial condition at the time I (we) request such further credit You are hereby authorized to contact credit reporting agencies.

  • This electronic signature constitutes a legally-binding signature, in lieu of a traditional signature.

  • This electronic signature constitutes a legally-binding signature, in lieu of a traditional signature.

  • Document Request List

  • Accepted file types: jpg, gif, png, pdf.
  • Accepted file types: jpg, gif, png, pdf.
  • Accepted file types: jpg, gif, png, pdf.