Injan | Legal Funding

Personal Information

Letʼs begin your cash advance request by gathering a few basic details about you.

First Name *

Please enter your first name.

Last Name *

Please enter your last name.

Email *

Please enter a valid email.

Phone *

Please enter a valid US phone number.

Date of Birth *

Please enter your date of birth.

Address Line 1 *

Please enter your address.

Address Line 2

Please enter your address2.

City *

Please enter your city.

State *

Please select your state.

ZIP Code *

Please enter your ZIP code.

Do you have a law firm?

Yes

No

SOCIAL SECURITY SEARCH CONSENT

To proceed with your application, we kindly request your Social Security Number (SSN) and Driver's License Number (DL). This information allows us to verify your identity and ensure security against fraud. Please note that this search will not affect your credit score. Please take a moment to review the Consent Agreement carefully and provide your permission to continue.

Consent Agreement

I, , hereby authorize Injan ("Company") to conduct a search of my Social Security Number (SSN) for the purpose of verifying my identity in connection with receiving consumer legal funding from Injan. I understand and agree to the following:

Purpose of Search: The SSN search will be conducted solely to confirm my identity and ensure that no fraudulent or mistaken identity is associated with this transaction. The Company will not use my SSN for any purpose other than identity verification.
Limited Disclosure: The Company agrees to maintain the confidentiality of my SSN and any personal information obtained through the search. The results of the search will not be shared with any third party, except as required by law or for the purposes of verifying my identity.
Data Protection and Privacy: The Company will handle my SSN, with the utmost care and in full compliance with applicable privacy laws and regulations, such as the Texas Data Privacy and Security Act (TDPSA), General Data Protection Regulation (GDPR), California Consumer Privacy Act (CCPA), and other relevant state and federal laws.
Voluntary Authorization: Voluntary Authorization: I understand that providing my SSN for this search is voluntary, but necessary for the processing and approval of my Funding Contract/Agreement.
Duration of Authorization: This authorization will remain in effect until the completion of the identity verification process. Upon conclusion of this process, my SSN and related information will be securely stored or destroyed, as per Company policy.

By signing below, I acknowledge that I have read and understood this consent agreement and voluntarily authorize the Company to conduct a search of my SSN for the purposes stated above.

Driver's License (DL) *

Please enter a valid Driver's License.

State of Driver's License *

Please select the state of your Driver's License.

Client Name

Date

Social Security Number (SSN) *

Please enter a valid Social Security Number.

By checking this box, I confirm that I have read and agree to the Consent Agreement and authorize Injan Legal Funding to send text messages to the phone number provided. Messages may include updates on my funding contract, such as pending amounts owed, or security-related messages like multi-factor authentication (MFA) codes. Message frequency may vary. Standard message and data rates may apply. To opt out, reply ‘STOP’ or ‘UNSUBSCRIBE’ at any time.

You must accept the Consent Agreement to proceed.

Attorney Information

To proceed with your application, we kindly request details about your partnered law firm and paralegal. Providing this information will help us coordinate efficiently with your legal team, ensuring your request is processed promptly and without delays.

Law Firm's Name *

Please select a law firm.

Paralegal's Name *

Please select a paralegal.

Paralegal's Email *

Paralegal's Phone *

City where your Attorney is located *

Accident Details

We kindly request that you share details about the accident you were involved in. This information allows us to better understand your situation and provide the assistance you need.

Injury Details

We kindly ask you to share some details about the injuries you sustained due to the accident. This information allows us to better understand your situation and provide the assistance you need.

What type of healthcare facility did you receive care at? Select all that apply.

Urgent Care

Emergency Care

Trauma Center

Primary Care Physician

Physical Therapy Center

Please select at least one healthcare facility.

How many nights did you stay at the hospital?*

Please provide the number of nights.

What was your diagnosis?

Please provide details about the diagnosis.

Advance Amount

How much financial assistance do you need during this challenging time?

Advance amount needed ($) *

Please enter the amount needed.

Application Form