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Secure Case Referral Form to Get Structured Settlement Annuity Quotes, Structured Attorney Fee, Structured MSA, Treasury Funded Structured Settlements, Structured Installment Sale Quotes, Divorce Structured Settlement Quotes, Employment Structured Settlement Quotes, Quotes for Structured Celebrity Endorsement Fees, Structured Real Estate Broker Fees, Structured Long Term Disability Settlements
Fields marked with * are required. Fields marked ** refer to instalment sales
  Referring Contact: Defense/Buyer's Counsel ** :
Your Name: * Name:
Phone: * Firm:
Email: * Phone:
Fax: Fax:
Claim or File#: Email:
Date of Loss:
Insured/ Defendant./Respondent:
  Claimant/Plaintiff/Seller **: Plaintiff's /Seller's Counsel **:
Name: * Name:
Sex: * Firm:
DOB: * Phone:
State of Residence: Fax:
Type of Case: Email:
  I/we would like to see structured settlement proposals developed with a total annuity cost of:
$ $ $ $
Please calculate the cost of per
month year with  Level Payments or with Cola of
  1%  2%  3%  4%  5%  Index-Linked(USA) / RPI (UK)

My client or I have an interest in discussing Settlement Planning Life Insurance Settlement Preservation Trust Special Needs Trust NY 50A or 50B calculation Structured Attorney Fee (Annuity Funded) Structured Attorney Fee (Non Annuity Funded Alternative) Structured Attorney Fee Maximizer Treasury Funded Structured Settlements Structured MSA (Annuity Funded) Structured Sale**Real Estate Exit Strategy (IRC 453) Ways to Protect My Recovery Structured Sale**Business Exit Strategy (IRC 453) Divorce Structured Settlements Environmental/Pollution Structured Settlements Structured Celebrity Endorsement Fees Employment Structured Settlements 1031 Exchange alternative Long Term Care Insurance for Me Long Term Care Insurance for My Parent(s) Disability Insurance Medigap Insurance How you can help us at mediation "In Force" Structured Settlement Payments for my pension plan Blended Product Solutions Retirement Annuity Income Annuity Buy/Sell Agreement Having you come talk to me/us on topic detailed in comment box below Life Care Funding for Long Term Care My Sudden Money® event and help managing my financial transition
  NOTE: We solicit annuity and insurance business only in states where we are licensed
  Forward proposals to: Referring Contact Defense Counsel Plaintiff's Counsel
Need by Date     Time
  Please copy: Referring Contact Defense Counsel Plaintiff's Counsel Other (detail in comments below)
  Please include information on any additional annuitants below. Please include additional comments that may help us to help you:

For structured settlement quotes, Please forward the following by email, or via FAX to 203-547-6110 or (0207) 138 2578 from UK:
  • Copy of Case Caption (from pleading, if in suit)
  • Names of Insurer(s) , expected contribution to settlement and on behalf of whom.
  • If any claimant/plaintiff/seller has a medical condition which might give rise to a rated age please fax medical information describing conditions. Please do not email confidential medical information.
Watch John Darer's LBN podcast "What You Need to Know About Structured Settlement Quotes


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