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Contingency-fee Law Firms
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Approximate Revenue, Net of all Payments to Clients and Co-counsel
2024 EST

Current Docket Composition
Legal Matter
Number of Clients
Estimated Fees
Does the law firm currently owe back taxes?

1. Do you currently owe back taxes personally?(Required)
2. Have you or an entity controlled by you ever filed bankruptcy?(Required)
3. Has any creditor ever foreclosed on or repossessed any asset of yours and/or any entity controlled by you?(Required)
4. Have you or any entity controlled by you settled a balance with any creditor for less than the full balance due?(Required)
5. Have you ever been arrested or the subject of a criminal investigation?(Required)
6. Have you ever been disciplined by or do you have a pending disciplinary action with a State Bar?(Required)


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.


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.