EmailMe Form - Advantage Investigations

Requestor *
Company *
Address (new requestors only)
Email *
Phone number
Claim and/or file number
Type of investigation
Type of claim
Claimant / Subject name
First Last
Male
Female
Address
Attorney represented? *
yes
no
Phone number
Phone number
Date of Birth
Date of loss
Injuries
Known Vehicles
Photo or file upload
Photo or file upload
Photo or file upload
Photo or file upload
Photo or file upload
Insured
Insured address (if different)
Treating facilities
Upcoming appointments
Additional Info
Use of this for is strictly for investigations requests. Abuse or SPAM of this form will not be tolerated and may result in a processing fee. *
I acknowledge the above permissible usage and agree to the terms.
We will respond to this request within two (2) hours