Sell Settlement-Buy Settlement-Sell Structured Settlement

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Structured Settlement Purchase-Request-Information Worksheet

A Structured Settlement is a contract to receive periodic payments based on a lump sum court decision resulting from some form of physical or tangible harm. You will have received an Annuity Policy defining all the terms and payment schedule.

To receive a NO-COST Cash Purchase Quotation to sell all or part of your Structured Settlement, complete the Settlement Information below.

Click the SUBMIT button at the bottom of the form after you are satisfied with your answers.

That's all you have to do!

Following your Submission of Settlement Information, your own personal Loan Supervisor will contact you with either a Settlement Cash Purchase Quotation to buy your Structured Settlement or more questions.

* Fields marked with an Asterisk are Required Fields.

Name *
E-mail Address *
Today's Date: *
Mailing Street Address: *
Mailing City, State and Zip: *
Voice Phone: *
Fax:
Settlement Owner Relationship: *
Original Settlement $ Amount: *
Current Settlement Balance $ Amount : *
Assignee Name (if None, enter 'None'): *
Annuity Policy Company Name: *
Payment Amount: *
Annuity Policy contains Inflation adjustments? *	Yes No
All Payments are Guaranteed? *	Yes No
1st Payment Due Date: *
Next Payment Due Date: *
End Payment Due Date: *
Payment Period: *
# of Payments Remain: *
Desired Sale Amount: *
Reason for this Court Judged Settlement: *
Recipient Age: *
Comments:
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What Keywords did you use to find us?

* Fields marked with an asterisk are required fields

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