Lawsuit Financing, Cash for Annuity, Presettlement Funding, Structured Settlement and more...
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General Application

Please use this form to provide us with additional details on a Lump Sum Payment you want to receive. Please fill in all appropriate information. This Application is NOT Secure and no credit related questions are required. Thank you.

Only complete those questions that apply to you!

 
Contact Information
*Name
Address Line 1
Address Line 2
City
State
Zip Code
Day Phone
Evening Phone
Fax
 *E-Mail
Seller's name
State of winning or settlement
 
Kind of Settlement
Personal Injury VSI/VA disability
Lottery Law firm receivable
Third party/workers comp Royalties
Other (please explain briefly)
 
Monthly Payments
 Do you have monthly payments?  Yes    No
 Payment amount $
 Total number of payments  
 Beginning date Yr
 End date Yr
 Percent increase (if applicable) %
 Increase occurs  Annual
 Every   years
 Annuity (insurance) company
 Payments issued by  Direct Deposit    Check
 
Lump Sum Payments
 Do you have lump sum payments?  Yes    No
 Date of payments Amount
Yr $
Yr $
Yr $
Yr $
Yr $
 
(shaded area) For Military Retirement/VSI/VA Disability Only
 
If disability:
What is the disability and its extent?
 
Gross Amount $
 
If military:
Pay Grade 		Rank Branch of Service
 
Tax deductions from Gross: Federal tax $ State tax $
 
Other deductions from Gross:
 		 Describe   Describe
Amount $    Amount $
Net Pay $
 
Do you want to sell all payments?  Yes    No
I want to sell enough payments to raise $
Are you able to work?  Yes    No
 
Reason you are selling:
 
How did you hear about us?
 
 
To help in our marketing efforts, please give us the name of the publication, station, search engine, person, etc. which led you to our web site.
 
If you found us through a search engine on the internet, please tell us which words you typed to locate our site.
 
Additional Information/Comments:
 

Click "Submit" to send this form.

 
 
Advantage Financial Consulting, Inc., arranges for the cash payment for the purchase of mortgages, notes, seller financed mortgages, FSBO, settlements, liens, mobile home notes, royalty payments, trust deeds, privately held mortgages, lease options, business notes, legal settlements, lotteries, annuities, real estate notes, structured settlements,  inheritances, portfolios, car paper, commercial loans, and other notes that originate in the United States only. If you have questions please contact us for further details. 1 866-537-8358 Fax 866-625-1688 (outside the USA call 1 954-724-0020)
 

 
We provide Lawsuit Financing, Pre-settlement Funding, Annuity Advance and Cash Advance Assistance
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