Attorney Questionnaire


Paralegal/Attorney Name:
Paralegal/Attorney Email
Law Firm and Phone number:
Client's Name:
Amount of Special Damages:
Liability Insurance Limits:
UM/UIM Insurance Limits:
Does Client have Health Insurance
Any settlement offer and amount:
Are there or do you anticipate any other Liens against this file?
Any other comment/information regarding this case?
After you submit the information, please send us the following: 1. Copy of the Accident Report; 2. Summary of Special Damages; 3. Pertinent Medical Records; 4. Any other information useful in evaluating this case. Please Scan/Email the requested information to info@greatbaycapital.com or you may fax it to (843) 724-6480.