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)*

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

Notes

Documents Uploads

Max. file size: 128 MB.

Please make sure to include below the declaration page in effect when the loss occurred.

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