LOTTERY / GAMING ADVANCE - QUOTE

General Information

Recipient's Name
Email
Contact Telephone
What is the Best Time to Reach You?	Please Select... Morning Afternoon Evening
Recipient's Address
City, State Zip

Lottery / Gaming Information Worksheet

Lump Sum Cash You Need Now
Name of Insurer or Agency Paying You
Type of Payment being Received	State Lottery Gaming Award Other Annuity/Award
Current Payment Amount
How often is payment received?	Monthly Quarterly Annually
Total Award You Won
Date of 1st Payment
Payment to be Paid Through date
State, casino, etc. where this award was won and details
What are your current needs? (Why do you wish to sell?)