The following information are
needed for us to grant your request in selling your annuity lottery winning payments.
You may submit this form to us by
printing it out and faxing it to us and we will contact you within 48 to 72 hours with a "lump sum"
quote based on the information you provide us below.
What type of prize was it? _________________________
__ State Lottery __ Casino Winning __
Other (Specify) _______________
Have you sold any payments before? __ Yes __ No
If YES, to what company? ______________________
What was the Win Date? _______________________
Were you the only Winner? __ Yes __ 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 stste do you reside in? _________________________
How many payments would you like to sell? _____________
How much money are you looking to obtain? ____________
_________________________
Print out and mail this sheet to:.
Cash Flow Funding
c/o O'Hara Enterprises
544 Norwood Street
East Orange, NJ 07018
or call us with this information by phone:
973-474-6619
