Lottery Winnings DELMarVA Judgment Services

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Lottery Winnings & Sweepstakes Worksheet
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Winning Detail
*What was the EXACT Win Date:?*
*What was the EXACT Total Amount Won:$*
*What is the GROSS Payment per year before tax withholding:$*
*What is the Annual Payment Date:?*
*What State is the Lottery From:?*
*What is the Total Number of Payments Involved:?*
*What is the Date of the Last Payment To Be Received:?*
*How Much Immediate Cash Do You Need:$*
*Why Do You Want To Sell:?*	Tell us your situation.
Comments:
The data, which we collect from you is not an application for credit. The intent of this form is for us to determine if a relationship between DELMarVA Judgment Services and/or its assigns and you and/or your company would be mutually beneficial. By submitting the required form, you authorize DELMarVA Judgment Services and/or its assigns to access any credit reporting agencies for which we are a member in your security interest under any agreements and transactions relating to DELMarVA Judgment Services and you and/or your firm. Your information is held in the strictest confidence and is used to help you achieve your goals in an expeditious and professional manner. _____________________________________________