INTRODUCTION
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REFERRAL
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We purchase
Gaming Awards Form
Your Name:
*
Phone:
*
Fax:
E-Mail Address:
*
Award Information Worksheet
Name of Entity Paying You:
*
Type of Payment Being Received:
*
Lottery
Vegas-Style Gaming Award
Annually
Current Payment Amount:
*
Total Award Amount (if known):
Date of Your 1st Payment:
*
Is This a "Life" Payment?
*
Yes
No
If Not a "Life" Payment What is the Final Payment Date:
Are You Seeking
*
Total Cash Out
Partial Cash Out
Why Are You Seeking These Funds?
What Are Your Current Needs?
Please answer the math question. The sum of 8 + 5 =
*
ImmediateCash.com
Creative Investment Group, Inc dba ImmediateCash.com
2400 W. Magnolia Blvd
Burbank, CA 91506