Time of Need Financial - Helping Plaintiffs and Families in a Time of Need

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Attorney Questionnaire
Plaintiff Information

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First Name

Last Name

Number Phone

( )

Email Address

I require:

Contact Preferences

Phone

Attorney Questionnaire

Client*

First Name

Last Name

Client's Social Security #

Attorney*

First Name

Last Name

Attorney's Firm Name

Street Address

City

State

Zip Code

Attorney's Phone Number

Attorney's Fax Number

Type of Case

Date of Accident

Property Damage $

Wage Lost $

Suit Filed?

Arbitration/Mediation/Trial Date (xx/xx/xxxx)

Award

Case Number

County of Court

Offer Amount

Demand Amount

Case Value

Settlement Prospects

Injuries

Surgery?

Prior Injuries

Total Medical Bills

Fist and Last Date of Treatment

Defendant's Insurance Company

Claim #

Policy Limits

Attorney Fee

Litigation Cost

Medical Liens

Lien Holder

Additional Comments

TNF - Time of Need Financial

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Attorney Questionnaire