Regal Funding

Apply Online Today! Apply at Regal Funding!

Your Information
Full Name: *Please enter your name.
Date of Birth (month-day-year):
Zip Code:
E-mail Address: *Please enter your valid e-mail address.E-mail is not a valid format.
Social Security Number:
Phone Number: *Please enter your phone number.
Your Attorney Information
Attorney's Full Name: *Please enter your Attorney's Name.
Name of Law Firm:
Phone Number:
Fax Number:
Zip Code:
Law Firm Contact (paralegal/legal assistant):
Have you ever been injured in an incident or accident prior to this case?:
If yes, provide details:
Funding Information
Amount of Funding Requested: *Please enter the amount of funding requested.
I need these funds for:
Please provide funding via:
Western Union
Direct Deposit
Pre-paid Debit Card
How did you hear about us?
By submitting this form, I agree that all the information listed is accurate and correct.

In order to obtain information about your case, we need your authorization to release your case records and information to us. We cannot proceed without it.
Enter your ATTORNEY’S NAME here:

I request and authorize my attorney to provide Regal Funding with whatever information (whether oral or in writing) needed to evaluate my funding request. I specifically waive any privilege that I may have regarding such information.

I hereby request and authorize your firm to cooperate with and release to Regal Funding any and all information and documents pertaining to my case. Please share your candid opinion regarding this action with Regal Funding, so that Regal Funding can evaluate my funding request.

I acknowledge that I understand the benefits and risks of non-recourse funding. I further acknowledge that I understand the effects of disclosing the contents of my file, including waiver of the attorney-client and work product privileges.

Thank you in advance for your cooperation.


* By clicking submit, you indicate that you have read and agree to the Records Release Authorization. This authorization gives us permission to contact your attorney and discuss your case with your attorney.

By submitting this form I agree that all the information listed is accurate to the best of my knowledge.

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Any questions?
Please feel free to contact us:
14 Penn Plaza Suite 2004
New York, NY 10001