Structured Settlement Funding Application Are you receiving payments from a structured settlement? Do you need money?...
Name: Email: Phone: Name of Insurance Company paying the settlement: State client lives in: State settled in: What type of settlement: car accident personal injury wrongful death other Have you sold payments before: Yes No How are payments paid out: Monthly Payment Amount: Paid on what day of month: Do payments increase: If yes, date and amount of increase: If client receives lump sum payments when are they due and how much: How many payments would you like to sell: How much money would you like to get by selling these payments:
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