Refer a Case

If you are interested in obtaining a structured settlement quote on a pending case use the form below to refer a case to Legacy Settlements Group.

First Name

Last Name

Email address

Phone Number

Address

Medical Information

Name of Attorney Representing Claimant

Name of Firm

Firm Phone

Firm Fax

Firm Address

Firm Email

Name of Attorney Representing Claimant

Name of Firm

Firm Phone

Firm Fax

Firm Address

Firm Email

I hereby consent to having this website store my submitted information so that they can respond to my inquiry.

I hereby consent to having this website store my submitted information so that they can respond to my inquiry.