Counsel Cash

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.

Use of the capital*

Use of funds?*

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

Full legal name*

Full legal name

Date of Birth*

Primary home address*

Primary home address

Driver’s license state/ID number*

Work telephone number*

Work email address*

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

State where you received your law license

State Bar ID number

Whether your law license is currently active

Whether you have ever been disciplined by a State Bar

Whether you have ever been sanctioned by a court in any jurisdiction

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

Law school and year of graduation

The number of years they have practiced law

Their primary practice areas

Their primary practice areas:

The number of cases that they have tried to verdict

The number of cases that they have tried on appeal

The number of cases that they have settled

Any professional awards

Martindale-Hubbell rating

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

The dollar amount of any tax liens, judgments, or other liens levied in the last five years. If the lien or judgment is not satisfied, please state the initial and current amount of the lien or judgment.

Have you or any business entity under your control ever filed for bankruptcy? If yes, please explain in detail.

First

The current balance (in $) of secured debt (e.g., mortgage, line of credit, etc.), the initial amount loaned (in $), and the name of the financial institution:

Total amount (in $) of unsecured debt (e.g., credit card):

Have you ever taken out a loan either for personal or business purposes and not paid back the lender the full amount including interest? If yes, please explain. No

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

Full legal name

Full legal name:

Type of entity (PLLC, PC, etc.)

Type of entity (PLLC, PC, etc.):

State where formed/organized

State where formed/organized:

Current address

Current address:

Website address

List any previous addresses in the last five years

List any previous addresses in the last five years:

List the names of every individual and/or entity that has equity ownership in this entity

Full time partners

The number of full time associates

The number of full-time attorneys of counsel

The number of full time paralegals/legal staff

Do you have a full time CFO or controller?

Please list the following information regarding your law firm:

The number of full time partners

The number of full time associates

The number of full time attorneys of counsel

The number of full time paralegals/legal staff

Do you have a full-time CFO or controller?

Please list the following financial information regarding your law firm:

Estimate (in $) of legal fees currently due (i.e., fees from cases settled not paid):

Estimate (in $) of case costs currently advanced to clients:

2018 Revenue (in $):

2017 Revenue (in $):

2016 Revenue (in $):

The current balance (in $) of any secured debt (e.g., term loan, line of credit, etc.), the initial amount loaned (in $), and the name of the financial institution:

Total amount (in $) of any unsecured debt (e.g., credit card):

Does each partner of the law firm maintain malpractice insurance?

Does each partner of the law firm maintain life insurance?

Please describe and provide the dollar amount of any liens, judgments, or tax liens currently filed against your firm.

Please describe any current or pending litigation involving your firm or any equity partner.

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.)

Case Type

Number of Cases

Case Type

Number of Cases

Case Type

Number of Cases

Case Type

Number of Cases

Case Type

Number of Cases

Case Type

Number of Cases

Case Type

Number of Cases

Please list the following information for your law firm:

What is its mission statement?

How does the firm incorporate its mission statement into its daily operations?

Does your law firm have a non-financial reason for existing? If yes, please explain.

Please list the dollar amount of charitable contributions that the law firm and/or equity partners made in 2017.

How many full-time employees have left the law firm in the past five years?

Please list any metrics or procedures the firm has in place to gauge employee satisfaction.

Please list any metrics or procedures the firm has in place to gauge client satisfaction.

Please list the name of each equity partner’s mentor and the frequency with which they speak to their mentor.

Please list the approximate number of hours the law firm dedicated to community service in 2017 and cite some specific examples of the law firm’s work

Please list the approximate number of pro bono hours the law firm performed in 2017 and cite some examples of the law firm’s work.

Please list the name of the case management system that your firm currently utilizes

Please list the names of all the marketing firms that your firm currently utilizes and how long you have worked with each marketing 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.

Signature No:1*

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

Title

Date

Signature No:2*

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

Title

Untitled

Date

Document Request List

Law Firm Formation Documents:

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.

Law Firm Financial Documents:

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.

Law Firm Docket Records (as applicable):

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.

Second Form

Second Form

APPLICATION

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:

Acknowledgement & Agreement

Document Request List