We are ready to roll up our sleeves and start working for you. Use the form below to create your request, and share all the relevant details. This information will be kept confidential. Once you submit, we can begin working on the case. Once we review the information, we will reach out with billing information. All major CCs, Google Pay, and Apple Pay are accepted.

REQUEST MADE BY *

First Name

Last Name

DIRECT PHONE *

(###)

###

####

LAW FIRM ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

RUSH? (n/a on DISCOVERY submissions)

NO

YES, 4 hours (same day) $150 -Personal

YES, 12 hours (next day) $85 -Personal

YES, 2 Biz Days $50 -Personal

YES, 4 hours (same day) $275 - Commercial

YES, 12 hours (next day) $200 - Commercial

YES, 2 Biz Days $100 - Commercial

DATE OF LOSS *

There are varying additional fees for cases with a date of loss beyond 1 year.

MM

DD

YYYY

DEFENDANT DATE OF BIRTH (IF KNOWN) *

MM

DD

YYYY

DEFENDANT ADDRESS (if known)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

DEFENDANT PHONE NUMBER (IF KNOWN)

(###)

###

####

DOES THIS INVOLVE A VEHICLE ACCIDENT

YES

NO

IS DEFENDANT INFORMATION THE SAME AS POLICYHOLDER INFORMATION? *

YES

NO

NOT APPLICABLE

ADJUSTER NAME

First Name

Last Name

ADJUSTER'S PHONE NUMBER

(###)

###

####

Have you uploaded ALL the supporting documents your team has? Police Report, Insurance Card, LOA, Image of the def driver's license can all HELP EXPEDITE and increase chances of results. Please do so now. *

Yes

DO YOU ACKNOWLEDGE AND ACCEPT OUR TERMS AND CONDITIONS? *

Yes