Reminder: Submitting this form does not commit you to selling your claim. You'll have the opportunity to review your offer prior to making any decision. If you choose to accept it, payment is typically sent within one business day.
You will receive
48.5%
of your settlement amount
after complete review
49.25%
49.75%
Each form must clearly show your name and your address, andbe dated within the last three months. Submitting random or blurry images will delay our ability to send you an offer.
Examples: