Injan | Legal Funding

Personal Information

We need to gather some basic details about you to verify your eligibility for a cash advance and ensure we can follow up with 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 move forward with your application, we kindly ask you to verify your Social Security Number (SSN). This helps us confirm your identity and ensures a smooth process for your cash advance request. Please review the information carefully and provide your consent 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 need some details about your legal representation. This information ensures we can coordinate effectively with your attorney to process your request without delays. Please provide accurate and complete information about your attorney and their firm.

Attorney’s Representative or Attorney’s Paralegal *

Please enter the attorney's name.

Attorney's Email *

Please enter a valid email address.

Law Firm's Name *

Please enter the law firm's name.

Attorney Phone *

Please enter a valid law firm's phone number.

City of Law Firm *

Please enter the city of the law firm.

Tell us more about the accident

Kindly share additional details about your accident that you’re aware of. If you’re unsure about something, feel free to select "I don’t know".

Injury Details

To provide the best support, we kindly ask you to share some details about the injuries you sustained due to the accident. Please answer to the best of your memory.

What was the diagnosis?

Please provide details about the diagnosis.

What is/was the treatment?

Please provide details about the treatment.

Did you miss work due to the injuries?

Yes

No

Please select if you missed work due to the injuries.

Requested Amount

Let us know the exact amount of financial assistance you need. This will help us process your request quickly and provide the support you require during this challenging time.

Exact amount needed ($) *

Please enter the amount needed.

Application Form