Application - LegaLender.com | Get paid for your case now, repay only if you win

Name*

First Last

Date of Birth*

Email*

Phone*

Address*

Street Address

Address Line 2

*

City

*

Postal Code

*

Province

Lawyer Name*

Please note that we will contact your lawyer to discuss your claim as part of our evaluation process

Please provide a brief description of the events leading to the claim

Please provide a brief description of your injuries, if relevant

Date of event leading to claim*

Do you have an existing loan relating to this claim?

Yes
No

I certify and declare that the information set out in this application form is true, accurate, and complete. I warrant and acknowledge that the contents of the application will be relied upon by Legalender in assessing risk, offering any terms, and providing any loans and will be the basis of and form part of any resulting loan offered by Legalender to me. I authorize and provide Legalender with the necessary consent to independently verify the accuracy of this information for the purpose of evaluating my application, including speaking with, and receiving documentation on my file from, my lawyer. I consent to the collection, use and disclosure of my personal information by Legalender for the purposes of evaluating and considering my application for Legalender services.

*

I have read and agree with above. *

Phone

This field is for validation purposes and should be left unchanged.