Online Case Intake Form

Name

First Name

Last Name

Company Name

How are you involved with this case?

Title

Address

Country

Address Line 1

Address Line 2

City

State

Zip Code

Please enter the phone number where you can be reached between 8:00 AM and 5:00 PM, Monday through Friday

Phone

Fax

TELL US ABOUT THE CASE

NAME OF CASE

Plaintiff v Defendant

Project Involved in Case

Project Location

Client

Services Required

Expert Witness - Standard of Care

Expert Witness - Cost of Repair

Destructive Testing

Other - Provide details in space below

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Thank you for using our online case information form.

You will be contacted within the next few business days by an associate at SC Wright Construction, Inc. for further information about your case and to answer any questions you may have.

If you have made the decision to retain SC Wright Construction, Inc. and would like for us to begin work on your case, continue to the next section.

If you are only seeking information as to our services and capabilities, you may stop here. We look forward to speaking with you.

ADDITIONAL INFORMATION

If you have decided to retain our services and would like for SC Wright Construction, Inc. to open a job file for this case, we will need additional information for classification and billing purposes.

Only complete this section if you are ready for a file to be established. If you are only interested in information about our services and/or how we can help your case, you need only complete the previous section of this form.

Starred fields are required for work to begin.

CLIENT'S INSURANCE CARRIER

Primary Insurance Carrier

ADDRESS

Country

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Fax

Claim Number or File Number

Insurance Adjuster First Name

First Name

Insurance Adjuster Last Name

Last Name

Checkboxes

There is an additional insurance carrier aligned with the client.

CLIENT'S ATTORNEY
Tell us about the client's attorney(s):

Primary Law Firm Name

Attorney Assigned to Case First Name

First Name

Attorney Assigned to Case Last Name

Last Name

ADDRESS

Country

Address Line 1

Address Line 2

City

State

ZIP Code

Case Number Assigned by Firm

Required field only if no insurance claim or file number is given

Phone

Fax

If an additional law firm has been designated as co-counsel in this case check here.

DEPOSITORY
If you know the depository designated for this case, enter information below:

Depository

ADDRESS

Country

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Fax

If you know who is retaining SCW (for billing purposes), select one of the options below

BILL SCW SERVICES TO:

Insurance Carrier

Law Firm / Attorney

Other

*CHECK BELOW IF IMMEDIATE ACTION IS REQUIRED*

Site Inspection Schedule

Emergency Repairs

Other

THANK YOU FOR USING OUR ONLINE CASE PROCESSING FORM
You will be contacted between 8:00 AM and 5:00 PM PDT the next business day by an associate as SC Wright Construction, Inc. to confirm the above information and answer any questions you may have.

If you are human, leave this field blank.

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Online Case
Intake Form

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