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Submit an Assignment Form
SFS File Number:
Date Opened:
File Manager Assigned :
By:
Date of Loss:
Type:
Investigation
Training
Location of Loss:
Insured's Name:
Insured's Phone Number:
Involved Parties Name:
Hiring Client Name:
Title:
Hiring Firm Name:
Hiring Firm Address:
Physical Address:
Office Phone Number:
Fax:
Cell Phone Number:
Email:
File Number:
Claim/Policy Number:
Invoice Sent To:
Billing Address:
How did you learn about us?
Already A Client
National Contract
Website
Mailer
Trade Show
Referral
Other:
Hiring Firm Type of Business?
Insurance
Law Firm
Individual
Industry
Tech. Specialty:
Type of Loss:
Residential
Commercial
Industrial
Oil and Gas
Marine
Involving:
Accident
Chemical
Marine Vessel/PWC
Civil
Product Defect
Common Carrier
Safety
Construction
Electrical
Explosion
Fire
LPGAS
Materials
Mechanical Systems
Vehicular
Other:
Assignment Type and Location:
Type of Report Requested:
Sent To:
Comments:
Evidence Storage:
Yes
No
Description:
Quoted Storage:
Per:
Quarter
Year
Retainer Agreement Completed:
Yes
No
Submitted to Staff
Assignment Price Range or Price Not to Exceed:
Please call us at 866-388-9334 if you have any questions. Thank you!