Terms of settlement (When and how much are you or will you be receiving)

Were you a minor when the accident/ incident occurred? No Yes

Have you sold any portion of your settlement previously? No Yes

Has any portion of your settlement been attached? No Yes
(for lack of payment to a creditor)

What is your credit rating?  A B C Unknown

Do you currently have any judgments or liens filed against you? No Yes

Do you or your spouse have any other source of income? No Yes

How did you hear of us? Search Engine Radio Add TV Add Newspaper Add Magazine Add Friend Other

If through Search Engine, Which one?  If Other please specify:

What Keywords did you use?

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