BACK TO LOTTERIES AND GAMING
•
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 =