Confidential Application

Please take a few minutes to complete the form below. We will handle the rest for you! We'll obtain the necessary documents from your lawyer and determine the no-risk, non-recourse cash advance amount you qualify for.

Please note Oasis does not provide funding of any case types in Ohio. Oasis does not fund Workers Compensation cases in Alaska, Arkansas, California, District of Columbia, Hawaii, Kansas, Kentucky, Massachusetts, Maryland, Michigan, Minnesota, Nevada, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Texas, Utah, Virginia, Washington, or Wisconsin.  

Your information is safe, secure and confidential with Geotrust protection.

Fields marked with a diamond are required.

1. CASE INFORMATION

Case Type:

Auto Premises Products Construction

Medical Malpractice Worker's Compensation Wrongful Death Other - including Commercial

State of Court:

State AL AR AK AZ CA CO CT DC DE FL GA DE HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Case Details:

2. CONTACT INFORMATION: Please provide the following information so we may contact you.

	Last name:
	First name:
	Date of Birth:	- 123456789101112 / - 12345678910111213141516171819202122232425262728293031 / - 200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929
	Phone Number:	- -
	Alternate Phone Number:	- -

	E-mail address:
	Home address:
	City:
	State:	State AL AR AK AZ CA CO CT DC DE FL GA DE HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
	Zip code:

3. AMOUNT OF MONEY REQUESTED: Please indicate the amount of money you need.

$

4. ATTORNEY INFORMATION

	Attorney Name:
	Law Firm Name:
	Phone number:	- -
	Fax number:	- -

	Address:
	City:
	State:	State AL AR AK AZ CA CO CT DC DE FL GA DE HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
	Zip Code:

5. LIENS AND ASSIGNMENTS ON YOUR CASE: Please indicate the liens and assignments (if any) on your case. If you do not have a particular type of lien, write "none" in the applicable box.

	Attorney's fees (ie. 33%):
	Other liens or assignments:

	Currently in bankruptcy:	yes no
	Changed attorneys in this case:	yes no
	Obtained a prior advance on this case:	yes no

If you answered yes to any of the above questions, please explain:

6. CERTIFICATION The information provided in this application is true, accurate, and complete, to the best of my knowledge and belief.

	Name:
	Do you authorize attorney to release documents to us to help fund your case?	yes no

Date:

***Submission of this application is not a guarantee that Oasis Legal Finance will offer to purchase a portion of applicant's potential settlement or judgement proceeds. Submission of this application is not a guarantee that applicant will accept any potential purchase offer made by Oasis Legal Finance, LLC.