use this quote form for Annuities, Structured Settlements
and Lottery Winnings.
If you are interested in selling a mortgage
note or a life insurance policy (viatical settlement), please
Your Contact Information:
Your Email Address
Day Time Phone
What type of structured settlement
are you currently receiving payments from?
Specific Payment Information:
Name of the company making payments to you:
Payments are made in the amount of:
If other, please specify:
Date first payment received:
Date of final payment:
If you are receiving lump sum
payments, please complete this section.
Please let us know of any additional
information or comments: