Pre Qualification Form
Application Request

Applying with us couldn't be easier. For your convenience, we've given you several methods to choose from. Simply select the option you prefer, and you'll be one step closer to attaining the settlement you are looking for.

Call us at 1-800-800-3264 to speak to a counselor personally and request an application packet. At this time, your counselor will answer any questions you might have concerning the entire settlement process and provide an initial assessment of your situation to determine if you qualify. At your request, your packet will be promptly mailed to you. The packet will contain important information regarding our services, as well as an application and authorizations that need to be completed in order for us to begin processing your case*.

Use our secure online Pre Qualification Form to determine whether or not you might qualify for a settlement. One of our counselors will review the information you provide, and will quickly contact you to let you know if you qualify or not. Upon qualification, your application packet will promptly be mailed out to you.

Request your application packet online by entering your name and address information by clicking here. Your application packet will be mailed out directly so that you may review the information in the privacy of your own home. Everything that you need in order to begin the settlement process will be included. If you have any questions at all while completing the information, a counselor is just a phone call away. It's that simple.

* We adhere to a strict confidentiality code. During the information gathering stage, only health and insurance professionals are contacted with your notarized information release forms. We will not contact anyone without your consent.

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