Claims Bureau New England; Assign an investigation securely online

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EMAIL ASSIGNMENT FORM

* Sent Securely (Encrypted) to Jerry@cb-ne.com

RUSH Needed by

INVESTIGATIONS: Auto, Workers Comp, Property....

STATEMENT SCENE LOCUS SCAR PHOTOS INTERROGATORIES BAILMENT LOCATE PUBLIC RECORDS OTHER (Please type below).

Investigation:

COMPANY INFORMATION
Company's Name
Your Name:
Telephone & Extension
E-Mail address:

Claim Number:
Insured's Name:
Date of Accident

SUBJECT #1:

Name:

Address:

City & State:

Tel. #:

DOB:

Lic No.:

SUBJECT #2

Name:

Address

City & State

Tel. #:

DOB

Lic No.:

Foreign Language

Subject Represented?
Subject's Name:
YES No

ATTORNEY INFORMATION

ADDITIONAL INFORMATION

Please fax or email supporting documents to

Jerry@cb-ne.com or FAX us at 800.257.3776

Thank You
For assigning an investigation to
Claims Bureau New England, Inc.

We will be in touch with you shortly.

Jerry Mulcahy 800.342.8877