Name
Email address
Phone number
What's the best time to reach you?
Name of Insurance Company paying the settlement?
State you live in?
What type of settlement?
Was this work related?
IF YES, WE CANNOT DO THIS DEAL -- STOP HERE
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Have you sold payments before?
If yes, to what company?
How are payments paid out?
Monthly Payment Amount
Paid on what day of month
Do payments increase?
If yes, date of increase?
Amount of increase?
If client receives lump sum payments, when are they due and how much?
Date / Amount
How many payments would you like to sell?
How much money would you like to get by selling these payments?
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