Date: Client:
Attorney:
Type of Case: D/A:
In Suit? Yes No Mediation Date: Award:
Plaintiff: Accept Reject Defendant: Accept Reject
Offer? (amount): Demand? (amount):
Case Value (Opinion):
Settlement Prospects: Good Fair Poor
Settlement Expected:  Within 30 days 30-90 days 90-120 day s Other
Trial Date: hard soft

Liability (Strengths/Weaknesses):

Injuries:

Prior injuries:
Insurance Co: Claim #:
Adjuster's name: Policy Limits:
Address:
Phone #: Fax #:
Defense Attorney's Name: Case #:
Address:
Phone #: Fax #:
Attorneys Fee: Litigation Costs:
Medical Liens: Other Liens:
Previous Lawsuit Funding Company::
Amount:: Payback:

Additional Comments:

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please contact Lawsuit Financial at 1-877-377-SUIT or email us.