Lottery Winning

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Name______________________________

Phone _____________________________

Fax _______________________________

E-mail: ____________________________

Date_______________________________

What type of prize winning was it?
__State Lottery
__IGT Casino Winning
__Other (specify) ____________

Have you sold any payments before? Yes or No

What was the Win Date? _________________

Were you the only winner? Yes or No
If no, how many other winners ________
What % did you win ________

What was the gross amount won? ____________

What is the gross annual payment amount? ____________

What is the net annual payment? ____________________

What State was the prize won in? ____________________

What State do you reside in? ________________________

How many payments would you like to sell? __________

How much money are you looking to raise? ___________


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