NOTE FUNDING CENTER
Best Buyer of cash flow assets since 1975
Structured Settlement Cash-Purchase-Quotation Request 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 our receipt of your Worksheet of Settlement Information,  your own personal Client Manager will contact you with either a Settlement Cash Purchase Quotation to buy your Structured Settlement or more questions.

* Questions marked with an Asterisk require answers from you.

* 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? *
All Payments are Guaranteed? *
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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