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The Perfect Home Based Business Opportunity
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Agent Name
*
Date
*
MM slash DD slash YYYY
Phone
*
Email
*
What type of prize winning was it?
*
State Lottery
IGT Casino Winning
Have you sold any payments before?
*
What was the win date?
*
Were you the only winner?
*
Yes
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?
*
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