Litigation Support Assignment Request Form

Law Firm Information
Law Firm Name (Company You Represent)
Name of Attorney handling this file*
First Last
Email of Attorney handling this file*
Phone Number of Attorney handling this file*
Law Firm Contact (Your Name)
First Last
Contact Email (Your Email)*
Contact Phone (Your Phone)*
Claim Information
Name of the Homeowner*
First Middle Last
Homeowner Email*
Homeowner Phone*
Physical Address of the property to be inspected*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Peril*
Date of Loss*
MM slash DD slash YYYY
Date of Loss*
MM slash DD slash YYYY
Date of Loss*
MM slash DD slash YYYY
Date of Loss*
MM slash DD slash YYYY
Insurance Company*
Policy Number*
Deductible Amount*
Did You File A CRN?*
- Yes
- No
Date of its Filing
MM slash DD slash YYYY
Notes
Documents Uploads

Please upload any and all documents that will help us prepare the estimate. Including correspondence from the insurance, dec page etc... Documents can also be emailed to info@flbestpa.com
Documents Uploads
Drop files here or

Max. file size: 128 MB.

Law Firm Information