This short application is your first step to getting the money you deserve! Submit it and we’ll get back to you as quickly as possible. ← BackThank you for your response. ✨ First Name(required) Last Name(required) Email(required) Phone Number(required) In which state did your accident happen?(required) Select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Are you currently represented by an attorney? Select an option YES NO What was the nature of your accident?(required) Select an option Motor Vehicle Accident Slip and Fall Trip and Fall Premises Accident Medical Malpractice Product Liability Other Not Sure Amount Requested Select an option $1.000-$10.000 $10.000-$25.000 $25.000-$50.000 $50.000-$75.000 $75.000-$100.000 $100.000-$125.000 $125.000-$150.000 $150.000-$175.000 $175.000-$200.000 $200.000-$250.000 Other Not Sure Feel free to leave any questions or concerns here: Terms of Service(required) By checking this box, you indicate you have read and agree to our Terms and Conditions. Submit Δ Like Loading...
Victim Funding 