Proposal Request

    First Name*

    Last Name*

    Date of Birth


    Email Address

    Phone Number*

    Are you represented by an attorney?

    If yes, attorney first and last name

    Amount to see structured

    Is this settlement for a minor under the age of 18?

    If yes, would you like to see college fund planning?

    Is this from a personal injury lawsuit?

    If not, what type of settlement is this?