Step 1 of 3

About you

Where to reach you

What state do you live in?

What kind of case?

Do you have an attorney?

First name

Last name

Mobile number

We only use this to call and text you about your application.

By checking this box I agree that Gain Servicing may call and text me at the number I provided, using automated dialing technology and artificial or prerecorded voice, about my funding request and follow-up if I do not finish it. Consent is not a condition of receiving funding. Message frequency varies. Msg & data rates may apply. Reply STOP to opt out, HELP for help. Privacy Policy

Email

For your funding documents.

By continuing you agree to our Privacy Policy.

Step 2 of 3

About your case

Attorney info, dates, and amount

We'll need your attorney's contact information, the date of your accident and the funds you need. We work with your attorney directly, you do not need to.

Attorney first name

Attorney last name

Law firm name

Law firm phone

If you have it.

When was the accident?

An estimate is fine; the day is optional.

How much do you need?

Step 3 of 3

Finalize your request

Confirm and submit

Have you already received funding from another company?

How should we contact you first?

By checking this box and submitting you agree to our Privacy Policy. No fee to apply. You owe nothing if you lose your case.

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Request received

Thank you, . A funding specialist will call you at during business hours, or first thing the next business morning.