American Land Contract Buyers - Free Quote Annuity Structured Settlement

First name:
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Last name:
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Your time zone:
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Best time to call you back with a quote:
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Area code & Phone number:
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Email address:
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Address:
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City:
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State:

Zip code:
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This annuity is the result of:

Briefly describe the circumstances under which this payment stream was created:
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Is this payment steam the result of a court ordered settlement:

Is this payment steam the result of an out of court settlement:

In what state was it settled:

Were you a minor at the time of settlement:
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On the front of the annuity policy who is listed as the Owner of the Policy:
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Name of insurance company that is sending your check:
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Payment frequency:

Amount of payment:
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Due date of next payment (month/day/year):
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Through what date are your payments guaranteed (month/day/year):
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Do your payments have an annual adjustment:

If yes what percent is it:
With what payment does the adjustment occur (month/day/year):
Do you receive lump sum payments:

If yes please list the date and amount of each lump sum payment due:
Reason for selling your annuity or structured settlement:
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What type of purchase are you interested in:

Is there a specific dollar amount you need to raise:
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Do you have and can you supply copies of the following documents:
Annuity policy:

Extended Release/Settlement Agreement:

Copy of most recent check or check stub:

Copy of front page of most recent tax return:

Do not enter anything in this field:

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