GT Universal - Structured Settlement Quote Request Webform

Structured Settlement Quote Request
Is this quote for the complete sale of the settlement note? *

You may state the lump sum you need now or the number of payments you would like to sell

Full name of settlement note owner (settlement winner) *

Contact person if different than owner

Address of note owner *

E-mail address

Daytime Contact Number *

Alternate Contact Number

Fax Number

Is this settlement court ordered? *

If no, describe the settlement situation (pre-settlement, etc)

Name of insurance provider or company paying you *

Original note amount (amount of the settlement coming to you) *

First payment date (If this is in the future, please go to and fill out the "Lawsuit Advance" form instead) *

Amount of payment you receive *

Frequency of payment (monthly, quarterly, etc) *

Please list the dates and amounts of the next three payments coming to you *

Final payment date *

Is the last payment you'll receive larger or a balloon type payment? *

Amount of last payout if different or balloon

Motivation for sale *

Any other details or questions


* Required fields