Investigative Services for the Insurance Industry.

Client Assignment Form

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Please completly fill out the form so we can promptly handle your submission

Client Information
Claim Number:
Company:
Adjuster:
Phone:
Fax:
Address Line 1:
Address Line 2:
State: Zip:
 
 
Insured Information
First Name:
Last Name:
DOB:
 
Address Line 1:
Address Line 2:
State: Zip:
Home Phone:
Work Phone:
   
Vehicle Make:
 Model: Year:  
Vehicle Operator:
Vehicle Owner:
   
Description of Loss:
Location:
Description:
Claimant Information
Claimant First Name:
Claimant Last Name:
DOB:
Address Line 1:
Address Line 2:
State: Zip:
Home Phone:
Work Phone:
Vehicle Make:
 Model: Year:
Alleged Injury:
Additional Information:
  More than one claimant?    Yes How many
Claimant Attorney Information
Claimant Attorney:
Phone:
Fax:
Address Line 1:
Address Line 2:
State: Zip:
 
 
Witness Information
Witness Name:
Phone:
Address:
State: Zip:
 
 
Additional Information
Instructions:
 

 

Divisions

Claims Advantage has three divisions that will cover all your needs.

Claims Adjusting Division
Multi-line insurance claims

Investigative Division
S.U.I Fraud, Surveillance and Corporate Investigations

Research Division
Skip Trace/Locate & Asset Searches and Background Investigations

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