BACK TO ANNUITIES     •     CONTACT US

Lottery / Gaming Award Quotation Form

Your Name
Your Email Address
Contact Phone		Contact Fax
Award Information Worksheet
Name of Entity Paying You
Type of Payment Being Received	Lottery      Vegas-Style Gaming Award   Other Annuity
Current Payment Amount
This Payment is Being Received	Monthly    Quarterly     Annually
Total Award Amount (if known)		Date of Your 1st Payment
Is This a "Life" Payment	Yes       No
If Not a "Life" Payment, What is the Final Payment Date?
Are You Seeking...	Total Cash Out    Partial Cash Out
Why Are You Seeking These Funds?  What Are Your Current Needs?
Please answer the math question.   The sum of 9 + 3 =