1. Fill Out The On-Line Application

If you don't have certain information, type 'N/A'. If you are sending the information separately, type ‘will forward’. Once the application is submitted, you will get a confirmation for your records. If you have any questions you can call us at 1-800-565-5177. To apply via fax or mail, click here to download forms.

2. Send Supporting Documents

The confirmation screen will list what RD Legal Capital needs to verify settlement of your case. We will contact you to confirm receipt of your application and let you know if additional documents are required.

3. Sign And Return The Assignment And Sale Agreement

We verify the settlement, and wire you the funds.

Assignor Basic Information:
Your Name:
Firm Name:
Firm Type:	Sole Proprietorship LLP Partnership LLC PC PLLC APLC PA Other (please specify below)
Address: (Street, City, State, Zip)
County:
Telephone:
Cellular:
Preferred Contact Number:
Fax:
Email:
Plaintiff Name:
Defendant Name:

Are you sole counsel on this case? Yes No If NO, provide Fee Sharing Agreement(s) with co-counsel and/or Referral Agreement(s)
Defendant Insurance Info:
Company Name:
Address: (Street, City, State, Zip)
Adjustor Name:
Email Address:
Telephone Number:
Claim Number:

Defendant Attorney Info:
Attorney Name:
Name of Law Firm (if applicable):
Address: (Street, City, State, Zip)
Telephone Number:
Date of Release:
Amount of Settlement:
Total Legal Fees:
Amount of Your Legal Fee: (Inclusive of disbursements)
Type of Case:
Comments: (e.g. amount requested if less than 100%)