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Albertson's Safeway - Structured Settlement Quote Request
Date
MM slash DD slash YYYY
Your Name
First
Last
Title
Division
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Acme
Denver
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Jewel-Osco
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Safeway
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Canada
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MM slash DD slash YYYY
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Injury or health issues which may affect life expectancy
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First
Last
Phone Number
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Defense Attorney Name
First
Last
Phone Number
Fax Number
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Medicare Set-Aside
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No
Amount of Seed Money
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Instructions / Comments*
RINGLER ASSOCIATES
The Nation's Largest Settlement Annuity Firm -- Safeway's partner in structured settlements
