Dear Client,

Please fully complete this application to the best of your ability. Answer all appropriate questions on this application even if it is a negative issue. You will want to let your new Funding Source know as much as possible. Our job is to help you get the cash you need. Any negative issues are not intended to disqualify you, but to allow us to confront these issues head on. So be accurate and truthful to the best of your knowledge. This is very important. You don't want to waste time, slow down your application, or not receive a quote at all!

Upon completion and submission of this form, you will receive an immediate email with your confirmation and funding source information. Please add “globalquickcapital.com” to your allowed email to ensure delivery.

Please note that these Applications are for conducting cash flow business or applying for loans only! These are not job applications!

Thank you,
GlobalQuick CAPITAL

Structured Settlements Application

Requirements

No Minimum
No Maximum
Accepted Locations: USA
Adults 18 and Over

Contact

•Contact First Name:

•Contact Last Name:

Title:

•Email Address:

•Phone Number:

Fax Number:

Cell Number:

•Date of birth:

•Marital Status:

Name of Attorney
(if applicable):

•Is payment a disability pension?

Yes No

If so, does disabled pensioner have a second source of income?

Yes No

Is client providing life insurance?

Yes No

If so, amount of coverage:

Payment Information

•Annuity payor:

Gross payment amount:

Tax deductions - Federal:

Tax deductions - State:

Other deductions from gross - Description:

Other deductions from gross - Amount:

Frequency of payments (number of months or years):

Date of next anticipated payment:

Client Information

•What is your motivation?

•How much cash do you need or want?

Date Needed:

Comments

Additional Comments:

•How did you hear about GlobalQuick CAPITAL?

Who Referred You?

No one referred me:

Referred Name:

Referred Phone:

Referred Email:

Application Id:

20241121-012840-693

Please note:

The Funding Source may require copy of additional documents
to make your quote. They will let you know by Email.

Upon submission of this form, you will receive an immediate email with your confirmation and funding source information. Please add “globalquickcapital.com” to your allowed email to ensure delivery.

Structured Settlements Application

Requirements

Contact

Payment Information

Client Information

Comments

Who Referred You?

Privacy Policy:

Security: