Lottery Winnings Application

Contact Information
*Name
Address Line 1
Address Line 2
City
State
Zip Code
*Day Phone
Evening Phone
Fax
*E-Mail
Seller's name (The actual owner or recipient)
State of settlement

Kind of Settlement
Annuity	Structured Settlement
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 (Months, Years)
Beginning date (First Payment date received)	Yr
End date (Date of Last Payment if applicable)	Yr
Percent increase (if applicable)	%
Increase occurs	Annual Every years
Annuity / Structured Settlement (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	$

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:

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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. 1 866-546-7416 Fax 866-625-1688 (outside the USA call 1 954-724-0020)