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QUOTATION FORM
	*	First Name:
	*	Last Name:
		Address:

		City:
	*	State:
		Zip Code:
	*	Phone:	Area Code: Number: -
	*	Email:
		Fax:	Area Code: Number: -

	*	Policy Type:
	*	Sex:
	*	Age:
	*	Medical Condition:
	*	Policy Face Amount:
		Policy Cash Surrender Value (CSV):
		Current Annual Premium Amount:
		Outstanding Loan Balance:

		Spouse's Information for Survivorship policies only
	*	First name:
	*	Last name:
	*	Age:
	*	Medical Condition:

		^* Required Field
		This result is not an authoritative rejection or approval of the proposed applicant's case. An application must be submitted for consideration before any approval or denial is determined by Invescor, Ltd. Also, the results of this life settlement probability calculator are relative to Invescor, Ltd. only and are not a universal standard for the life settlement marketplace. These calculations are based on Invescor, Ltd.'s experience working with life settlement providers.