I hereby authorize the designated representatives or any of their successors, assigns,
designees, agents or administrators to disclose, make available and furnish to Cash
Settlements Now any and all information pertaining to the settlement of my case
as set forth. I specifically direct that the attorney representing me in my case
or any of the successors, assigns, designees, agents or administrators cooperate
with Cash Settlements Now regarding disclosure of information related to the settlement
of my case. I also authorize Cash Settlements Now to pull consumer credit reports
and any information concerning liens and judgments against me. Please provide copies
via fax or otherwise of any and all documents requested by Cash Settlements Now.
I also request that my attorney share his candid opinion of my case with Cash Settlements
Now By submitting this form, I/we certify that all of the information provided above
is true and correct. I/we understand that any intentional misrepresentation on my/our
part will result in the immediate cancellation of any assignment or purchase made
in connection with this application.