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
Date Format: MM slash DD slash YYYY
Notes
Documents Uploads
Please make sure to include below the declaration page in effect when the loss occurred.
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Law Firm Information