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Free Structured Settlement, Annuity, lottery/Gambling Winnings Application Form

APPLY NOW!

Fill out the below free quote sheet and fax to

(630) 563 2325 

       FRANK KOVICH  

       (630) 229-5740

        Locator ID# 501582       

        E-MAIL: Quoteanote@gmail.com

    Please print out and fill in the blanks below. All fields are required. Please provide exact, accurate responses to each question and do not estimate anything. Instead, take the time to gather the information directly from your cash flow note or other paperwork. Remember, the offer we make you will be based directly on the information you provide, and if during due diligence we discover the information you provided was not completely accurate, we will have no choice but to modify or rescind our offer. HELP US HELP YOU!

For Structured Settlement, Annuity, lottery, Gambling Winnings Only

CONTACT INFORMATION

 

Type of Note

 

The person completing this form is

 

Annuitant's first & last name

 

Annuitant's/winners address including city, state and ZIP

 

 

 

 

 

Annuitant's/winners email address

 

Annuitant's/winners home phone

 

Annuitant's/winners work phone

 

Annuitant's/winners cell phone

 

Best time to contact you (if you have a preference)

 

Are you personally receiving payments on this note?

 

BUSINESS INFORMATION

 

Exact name & address of insurance company making payment(s)

 

 

 

 

 

 

Payment amount

 

# of  Payments are made

 

# of Payments remaining

 

Settlement resulted from what

 

Current age of Annuitant

 

PAYMENT DATES

 

 

 

List all of the EXACT payment dates (mm/dd/yy) and amounts for the payments you wish to sell (EXACT DATES ONLY - no estimates please)

 

 

 

 

 

 

 

 

 

MOTIVATION OF THE NOTE SELLER

 

Why are you selling this

 

How much cash do you need

 

When do you need the cash by

 

Do you prefer to sell your entire settlement (a full purchase), just sell a portion of the payments (a partial purchase), or do you have no preference

 

 

 

 

 

 

 

 

 

Comments or other pertinent information

Structured Settlement, Annuity, lottery, Gambling Winnings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Structured Settlement, Annuity, lottery, Gambling Winnings)

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