Request Form

Insurance Discovery Request

This form should be used to submit a request for an Insurance Discovery case only

(indicating you do not have insurance carrier information)
Have you worked with us before?*

YesNo

Requester Information
Law Firm*
Law Firm Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requester Name*

First NameLast Name
Requester Phone Number

Area CodePhone Number
Requester Email*
example@example.com
Is there an additional email you would like your results sent to?

YesNo
Additional Email
Additional email where your results will be sent.
Date of Request

MonthDayYear
You have selected to process an Insurance Discovery search.

This means you do not have any insurance information for the at-fault party and would like us to open an investigation to obtain this information for you. To process Insurance Discovery requests, we require a $150 minimum non-refundable deposit to be paid before we can begin our research.

This deposit secures the resources for our team to conduct research on your case using our basic scope of practice. If these efforts do not return successful results, you will have the option to continue the investigation upon payment of an additional $150 non-refundable deposit. This additional deposit allows our team to utilize more advanced resources and access additional sources of information to obtain your results. By purchasing the Extensive Deposit option upfront ($250 non-refundable deposit), you will not be required to submit payment for any additional deposits to continue the investigation for this case, regardless of resources used.

Upon receipt of successful results, the amount of non-refundable deposits paid will be deducted from the total invoice amount. If our search returns inconclusive at any point, you will recieve a detailed Summary of Findings from our Research Development Department and there will be no further charges to you.

Insurance Discovery standard processing time is 3-4 weeks.

To guarantee receipt of your results within 7 days, please choose the 7 Day Guarantee option. This will place your Insurance Discovery request at the top of our queue and will ensure that your results are returned to you within 7 calendar days. If results are not sent to you within the allotted timeframe, you will be refunded the $80 fee paid for the 7 Day Guarantee (you will not be issued a refund for the $150 non-refundable deposit, however).
You indicated the need for our Insurance Discovery service. This means you do not know the insurance carrier of the at-fault party and would like us to locate this information for you. Please verify that this is correct:*

Yes, I need to find the insurance carrier

Case Identification
Plaintiff's Name/Case Number*
Date of Loss*

MonthDayYear
Is this case currently in litigation?*

YesNo
What is the date this case was filed?

MonthDayYear
What is the county this case was filed in?
Are we conducting research on a policy covering an individual (personal policy), or commercial entity?

Individual (the named insured of the policy is an individual)Commercial (the named insured of the policy is a business or commercial entity)
Personal or Commercial?

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Case Information
Defendant Name*
Defendant Date of Birth

MonthDayYear
Defendant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Defendant Phone Number

Area CodePhone Number
Driver's License
Vehicle
VIN Number
Is Defendant information the same as Policyholder information?

YesNo
Name on Policy*
Policyholder Date of Birth
Policyholder Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Policyholder Phone Number

Area CodePhone Number

Additional Information
Supporting Documents

Please upload any supporting documents (ie., policy report, insurance letter, etc.)
Cancelof
Additional Notes

Submit Request
Invoice Number
Case Title
Processing Time*
Type of Insurance Discovery
Type of Case
Information Requested
Signature*

Clear
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