Send Us A Case

Send Us A Case

Do you or a client have a life insurance policy and want to know if it’s a good fit for a life settlement? Provide us with some information about the policy and the insured by filling out the form below. The more information you provide, the better we can qualify your case.

After you submit your case, a member of our team will review it and get in touch shortly. If your case qualifies for a life settlement, we’ll provide you with instructions to move forward.

Tell us About Yourself

Your Name*

Your Company's Name*

Your Phone Number*

Your Email*

Tell us About Your Case

Insurance Carrier

Face Amount/Death Benefit

Policy Type

Issue Date

Accumulated Value

Case Surrender Value

Loan Amount

Premiums

Premium Frequency

First Insured's Age

First Insured's Sex

Has the first insured's health changed since policy was issued?

Use the box provided to briefly describe the first insured's health.

Second Insured's Age (If applicable)

Second Insured's Sex (If applicable)

Has the second insured's health changed since policy was issued?

Use the box provided to briefly describe second insured's health.

Use the box below to provide us with any additional notes on the case that might be of value.

How Did You Hear About Us?

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