Who We Are | What We Do | Contact

ANNUITY AND SETTLEMENT WORK SHEET

BROKER INFORMATION
BROKER NAME PHONE
MAILING ADDRESS CITY
STATE ZIP
CLIENT INFORMATION
NAME PHONE
MAILING ADDRESS CITY
STATE ZIP
PAYMENT INFORMATION
ANNUITY IS THE RESULT OF POLICY NUMBER
NAME OF INSURANCE  COMPANY MAKING PAYMENTS
ANNUITANTS NAME ON POLICY
PAYMENTS  ARE MADE

MONTHLY QUARTERLY ANNUALLY OTHER

PAYMENT AMOUNT
NEXT PAYMENT IS DUE ON
DATE FIRST PAYMENT RECEIVED
DATE OF FINAL PAYMENT
ARE THERE LUMP SUM PAYMENTYES NO
LIST DATE AND AMOUNT OF EACH LUMP SUM PAYMENT DUEDATE AMOUNT $
CLIENT WANTS TO SELL ENOUGH PAYMENTS TO RAISE $
 
ANY ADDITIONAL COMMENTS OR INFORMATION
QUOTE INFORMATION
QUOTE FOR PAYMENT $
QUOTE FOR FULL PURCHASE $
COMMENTS
 

© Copyright 2006. Clayton & Associates

Site designed by: Chicago Web Design Chicago web design ditley.com