Annuity/Structured Settlement Quote Form

We Offer the Highest
Annuity Settlement Cash-Outs
because we have low overhead
and low-cost money

For more information Please call
Fred Coutts
at 206-281-3153
or 1-888-942-6639
Fax # 206-378-1070
Email Fred@FredCoutts.com
or visit our website at
Cash For Structured Settlement Information

To receive your quote please complete all fields. Thank you.

Seller Information

Seller's Name

State Seller lives in

City Seller Lives In

Seller's Street Address

ZipCode

Seller's Telephone Number(xxx)-xxx-xxxx

Email Address(if any)

Annuity Information

Exact Name of Company Making Payments

State where the insurance company is located

Date of Annuity

Please list date(month/day/year) and amounts of future payments

State where it was settled

Reason for Annuity

Thank you. We will respond to you within 24 hours, if submitted on Sat. or Sun., we will respond by Monday. Your information is secure and confidential.

Please contact Fred Coutts with any questions at 206-281-3153 or 1-888-942-6639
Fax # 206-378-1070
Email Fred@FredCoutts.com
Web: www.FredCoutts.com

Please Click on the Submit Button to Send Your Information

All Boxes must be completed. You know you have submitted when the form says "Your Page has been Submitted"

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