We Understand That
Contingency-fee Law Firms
Have Unique Needs
We Have Developed Fast, Flexible Products To Solve Those Challenges And Accelerate Growth.
We Move Quickly - Often In Less Than Three Weeks To Fund You.
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Your Name
Law Firm Name
Phone
Email
LAW FIRM INFORMATION
Number of Equity Partners
Number of Employees
Amount of Funding Requested
Primary Expected Use of Proceeds
Marketing
Case Expenses
Eliminate Existing Debt
General Overhead
Other
Approximate Revenue, Net of all Payments to Clients and Co-counsel
Year
2021
2022
2023
2024 EST
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Remove
Current Docket Composition
Legal Matter
Number of Clients
Estimated Fees
Add
Remove
Add
Remove
Add
Remove
Add
Remove
Dollar Amount of SBA COVID Relief secured Debt on Law Firm (EIDL)
Dollar Amount of non-SBA COVID Relief secured Debt and Fee Advances on Law Firm (Bank Debt, Specialized Financing, etc.)
Does the law firm currently owe back taxes?
Yes
No
Does the law firm currently have malpractice insurance?
Yes
No
EQUITY PARTNER INFORMATION
Names of Additional Equity Partners
1. Do you currently owe back taxes personally?
(Required)
Yes
No
2. Have you or an entity controlled by you ever filed bankruptcy?
(Required)
Yes
No
3. Has any creditor ever foreclosed on or repossessed any asset of yours and/or any entity controlled by you?
(Required)
Yes
No
4. Have you or any entity controlled by you settled a balance with any creditor for less than the full balance due?
(Required)
Yes
No
5. Have you ever been arrested or the subject of a criminal investigation?
(Required)
Yes
No
6. Have you ever been disciplined by or do you have a pending disciplinary action with a State Bar?
(Required)
Yes
No
If you answered “Yes” to any of the Equity Partner Information, please provide details
How did you hear about us?
Loan Consultant
Attorney
Lender
Email Campaign
Other
Disclaimer
The information collected on this application will only be used to respond to you about your request for financing. We will not share your information with anyone outside of our organization. Financing with B.E. Blank & Company will not appear on personal credit, nor will your application for financing impact your credit score.
Consent
I understand that I have the right to request additional disclosures concerning the nature and scope of B.E. Blank & Company's credit review, upon written request, within a reasonable timeframe. I understand that B.E. Blank & Company may reasonably rely upon all the information disclosed within this application and any all attachments in all respects. I understand that written or verbal communications by the partners, employees or affiliates of B.E. Blank & Company do not themselves constitute offers for financing. I understand further that all offers for financing are contingent upon the approval of the investment team of B.E. Blank & Company after completion of due diligence by its legally designated employees, which are validated through formal financing agreements.