Checkout

Pay ONLY When Your Case Is Settled And Won.

All monthly access fees are paid by your attorney.

Deferred Payment of all Case prescriptions accumulated are paid at the end of the case settlement.

Payment is designed to get the patient the near highest amount possible allowed by Law.

Membership Information

You have selected the Deferred Payment membership level.

The price for membership is $0.00 now.

Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name
LEAVE THIS BLANK

Already have an account? Log in here

Attorney

Bar Roll Number

First Name

Last Name

Firm Name

Address

City

State

Zip

Primary Address above is

Office

Residence

Phone Number

Fax Number

Attorney Credit Card on File

Name on the Card

Card Number

Expiry Date

CVV

Patient

Patient First Name

Middle Name

Last Name

Suffix JR/SR/II/III

Gender

Male

Female

Date of birth

Case# (If Applicable)

Mailing Address#

City

State / Zip

Date of Birth

Cell No#

Drivers License

Social Security Number

Employer Detail

Job Title / Job Description

Monthly Income

Processing…

The payment for all scripts accumulated is deferred until the case is settled or won. The settlement recovery is designed to get the plaintiff the near maximum $$ allowed by law. Business Ready evidence document of all costs records is provided to the Attorney upon demand request for Court, or Settlement.