Annuity And Structured Settlement WorkSheet

ANNUITY AND STRUCTURED SETTLEMENT WORKSHEET

Do you have an Annuity or Structured Settlement that you would like to receive a LUMP SUM

payout for? We are a nationwide buyer of Annuities and Structured Settlements.

To find out how much cash you can receive for your annuity or structured settlement just

provide us with the requested information below:

YOUR INFORMATION:
:
Name:*
Phone Number:*
Mailing Address:*
City:*
State:*
Zip Code:*
:
PAYMENT INFORMATION:
Annuity is the result of: Purchased,Inherited or Giftd:*
If Settlement; was it for: Court Judgment or Out of Court Judgment:*
Name of Insurance Company making Payments:*
Policy Number:*
Annuitants name on Policy:*
Payments are made: Monthly, Quarterly, Annually or Others:*
Payment Amount $:*
Next Payment Is Due On:*
Date First Payment Received; Month, Day and Year:*
Date Of Final Payment: Month, Day and Year:*
Are There Lump Sum Payments: Yes or No:*
List Date And Amount Of Each Lump Sum Payment Due Below:
Date & Amount:
Date & Amount:
Date & Amount:
Date & Amount:
Date & Amount:
Date & Amount:
Date & Amount:
:
How Much Money Do You Need To Raise $$:*
Any Additional Comments Or Information: