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**
Date Of Birth**
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?
What are the current medical conditions the insured is being treated for?
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?
What are the current medical conditions the second insured is being treated for?
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.
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