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On what date did the incident take place?

What type of case is this?

Personal

Commercial

What type of incident is this?

Please provide any additional details about your case and let us know how we can assist you.

File upload

This may include: police reports, claim forms, medical records, photos of the incident, insurance correspondence, driver’s license, insurance cards, vehicle registration or information, and any other supporting materials.

What is the Defendant's Name?

What is the Defendant's Date of Birth?

What is the Defendant's Address?

What is the Defendant's Phone Number?

What is the Defendant’s vehicle make, model, and year (if applicable)?

Where did the incident occur (e.g., dog bite, slip and fall)? Please provide the address if applicable.

Can you provide the name of the Defendant’s Insurance Provider?

Yes

No = Insurance Discovery Search

Who is the Defendant's Insurance Provider?

Policy Number

Claim Number

Company Name

Company Address

Requestor's First name

Requestor's Last name

Requestor's Position

Requestor's Email

Requestor's Phone

What is your Clients Name?

Please provide the Case Number, if available.

I have reviewed and provided all case information currently available to me.

I have read and agree to the Terms & Conditions and confirm acceptance of the applicable fee schedule for this request.

Terms & Conditions