CPT Case Submission Form
Hello! Thank you for considering CPT. Before we begin, we will need some basic information.
Email address *
Your Full Name *
Your answer
Role *
Contact Number *
Your answer
Best time to call?
Your answer
Case Name
Your answer
Is the individual disabled?
Is the individual unable to work?
Is the individual receiving Supplemental Security Income (SSI)?
Is the individual receiving Medicaid?
* Please note: Some states refer to their Medicaid program by a different name. Ex: CA = Medi-Cal
Is the individual receiving Medicare?
Is the individual receiving Social Security Disability Insurance (SSDI)?
Is the individual over the age of 64?
You're done!
*Remember: The only documentation required prior to a trust signing is a signed Social Security. Our bank will not accept funds without this document.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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