Structured Settlement Quote Form
Please complete and submit this form for a quote on: Structured Settlements, Casino and Lottery Winnings, Annuities, Senior Settlements and other payment contracts.
Sorry, We don't buy Veterans Administration Pension or V.A. Disability Contracts.
The Structured Settlement information submitted on this form will be held in the strictest confidence. (See our Privacy Policy)

For quotes on Mortgage notes please use our Mortgage Purchases Quote Form.


Your Email Address Phone
Name Fax
Street Address
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Payment Type (If other, please explain):

Payment Information
I receive:
payments of
Date first payment received:
Date of final payment:

Periodic Lump Sum Payments Due
Dates: Amounts:

Name of the company or agency making payments to you:
Any Additional Comments or Information:
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Please tell us how you found us:
If by search list keywords used:
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Alternately, you may print out this completed form and:

  • fax to us at 1-800-258-7204 or
  • snail-mail it to FDR Resources at 3 S. King St., Danbury, Ct., 06811
  • or phone us with the information at 1-800-338-5815.



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