LOTTERY AND CASINO WINNERS QUOTE SHEET

Name:*Address:

City:       State: Zip:

County of Residence:         

Day Phone:*  ()          Evening Phone: ()

FAX Phone:  ()         Work Phone:    ()

Best time to call: A.M.    P.M.    Eastern    Pacific    Central

E-mail address:*    Social Security No.:

Are you?  The Note Holder    Note Broker    Real Estate Agent

                      Referral Source      Other:

State of Winning:    Year of Winning:

Amount Won:     Date Won:

Date of First Payment:     Date of Last Payment:

Gross Yearly Payment:      Net yearly Payment:

Total Prize Amount:      Amount Desired:

• Letter certifying the prize money

• Proof of Identification

• Affidavit of Ownership

Have you ever used a cash flow broker before?    Yes     No

Have you been shopping this deal?  If  yes, what is the highest bid you received?

Who gave this bid to you?

Search Engine------------Name of search engine:        

Keywords Used--------------

Banner Ad----Where did you see our banner?

Classified Ad---------Where did you see it? 

Newsgroup--------------Which newsgroup?

Other: -----