New Case Request – Affirm PI

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Law Firm Name *

Email *

Additional email (If you want results to be sent to multiple emails)

Have you worked with us before? *

Requester's Name *

Phone *

Case Submission

Plaintiffs Name / Case Number *

Do you know the insurance carrier?

How soon would you like your results?

Standard Processing Time: 7 to 14 Business Days
Rush Processing Time: 7 Business Days

Since the insurance carrier is unknown, our standard processing time is 7 to 14 Business days.

How soon would you like your results?

Standard Processing Time
6 Business Hours
12 Business Hours

Standard Proccesing time: 3-5 Business Days for Personal cases | 5-7 Business Days for Commercial, AAA, Farmers, Mercury, State Farm,USAA | Next Day, Personal Expedited & Commercial Expedited processing times are subject to additional fees.

Date of Loss *

Type of Case

Personal Auto
Homeowners
Commercial
Umbrella
Commercial Umbrella
Policy Existence

Business Name and Address

Information Requested

Policy Limits
Umbrella Limits
UM/UIM for your Client
UM/UIM For Defendant
Policy Existence (Policy Number)
Defendants Contact Information

Defendant Information

* We need at least one piece of verifying information to ensure we are searching for the correct Defendant

Defendant Name *

First

Middle

Last

Defendant Address

Address Line 1

Address Line 2

City

State

Zip Code

Drivers License Number

Defendants Vehicle

Is the Defendant the Policy Holder?

Policy Holder Name

Policyholder Address

Address Line 1

Address Line 2

City

State

Zip Code

Policy Holder Date of Birth

Policy Holder Phone Number

Defendant Date of Birth

Defendants Phone

Vehicle Licenses Plate Number & State

Vehicle Vin Number

Insurance Information

Insurance Carrier

Claim Number

Adjuster Phone Number

Policy Number

Adjuster Name

Supporting Documents

Click or drag a file to this area to upload.

Additional Notes

Free Consultation: Call Us Today (877) 742-2783 | info@affirmpi.com

The information contained on this website should never be taken as legal advice.

Please contact our office for all of your investigative needs. If we are not able to assist you with your specific needs, we will help find an investigator who can.

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