Structured Settlements Contact Us Home
 

  
Your Contact Information

Recipient's Name

Email Address

Contact Telephone

      Contact Fax 

Recipient's  Address

City. State, Zip

    


Settlement Information Worksheet

Lump Sum Cash Required

Name of Insurer Paying You

Type of Payment Being Received

Pre-settlement    Structured Settlement
Retirement / Investment Annuity

Current Payment Amount

   Monthly   Quarterly   Annually

Total Award Amount (if known)

  Date of 1st payment   

Payment to be Paid Through (date)

   or...    Life Payment

Type of accident involved.  Reason for structured settlement payment.

What are your current needs?  (Why do you wish to sell?)

                                                             

                                                                    

 

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