Paperless Onboarding App

Name: Abacus Settlements
Address: 2101 Park Center Drive Suite #170,, Orlando, FL, 32835
Telephone: 800-561-4148

Paperless Online Application

Progress

INSTRUCTIONS

Our online eSign Intake Form instantly provides us with the information and authorization we need to do full underwriting and pricing on your settlement case. Please fill out the form fields to the best of your ability. Once complete, you will receive an email with eSign digital signature instructions. You can use your computer or tablet to sign our forms online instantly. Please call us at 800-561-4148 with questions. All information is kept secure.

Insured - First Name *

Insured - Last Name *

Insured - Date of Birth *

(MM/DD/YYYY). Required for eSign and HIPAA.

Insured - Social Security

Required for eSign and HIPAA.

Insured - Address

Insured- Phone

Insured - Email Address *

Required to recieve HIPAA doucments via email.

Do You Have a Second Person Insured on Your Policy?

Yes

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© 2020 Abacus Life Settlements. Disclaimer: Abacus Life is not approved in all States. Abacus Life is a DBA of Abacus Settlements, LLC. Due to the inevitability of internet to enter States without intention, this website or any other correspondence does not constitute a solicitation for business in any particular State. This site is not intended for Texas or Rhode Island residents. It is the responsibility of all intermediaries to follow the State laws and obtain any required licensure that corresponds to any particular financial or life settlement business in which they are engaging. Abacus Life will not accept business in States in which it is not licensed. The information contained in this site is not approved for or pertinent to Alaska or any other State in which Abacus is not licensed. We do not currently accept cases from AK,NE,ND,VT,WA,& WI. Copyright 2003-2019 Abacus Life.