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Annuity and Structured Settlement Sale Application
  1. Please fill out this form in order to receive a quote for your annuity or structured settlement payments.

  2. Contact Information

  3. First Name(*)
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  4. Last Name(*)
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  5. Email(*)
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  6. Telephone(*)
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  7. Telephone 2
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  8. Address
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  9. City
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  10. State
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  11. Zip Code
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  12. Annuity or Structured Settlement Information

  13. # of Payments Remaining
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  14. Amount
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  15. Increase %
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    If the payments increase annually, enter the percentage (%)

  16. Life Contingent Payments?
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    Check box if annuity is paid "for life" only

  17. Payment Frequency
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    For payments at various intervals, please describe in your message

  18. Name of Insurance Company
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    Name of the insurance company that makes the payments

  19. Your Message
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    See what kind of offer Corona Capital can give you for your structured settlement or annuity.
  20. Enter Characters
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