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Submit an Assignment Form

FFI 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 833-FIRE4N6 if you have any questions. Thank you!