Refer a Case — Z Settlement Advisors

Refer a Case

Please complete the form below

Referring Source *

First Name

Last Name

Email

Referring Source Contact Number *

Casualty Company *

Claimant Name *

First Name

Last Name

Claimant Date of Birth *

Also known as the annuitant

Claim number

Date of Loss

Type of Case IE Work Comp, Personal, Med Mal etc. *