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Presettlement Cash Advance Application

Please take a few minutes to complete the form below. We will handle the rest for you! We’ll obtain the necessary documents from your lawyer and determine the no-risk, non-recourse cash advance amount you qualify for.

Not Available to Residents of North Carolina. Happy Rock does not fund Workers Compensation cases in Alaska, Arkansas, California, District of Columbia, Hawaii, Kansas, Kentucky, Massachusetts, Maryland, Michigan, Minnesota, Nevada, New Jersey, New York,
North Carolina, Oregon, Pennsylvania, Texas, Utah, Virginia, Washington, Wisconsin or Wyoming.

First Name:
Attorney First Name:
Last Name:
Attorney Last Name:
Address:
Attorney Phone:
City:
State:
Zip:
Phone:
Email:
Case Information:
What state is your case in?
What kind of case do you have?
What was the date of the accident?
What body parts did you injure?
How much money do you need?
Have you had surgery because of your injuries?
Yes No
Do you authorize your attorney to speak with Happy Rock and/or release documents to us about your case?
Yes No
How did you hear about Happy Rock?