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Assignment Form

This Assignment Form is sent to the Investigative Engineers Association (I-ENG-A) Association Headquarters. I-ENG-A Association Headquarters will send the information to the closest member firm to the property/evidence location. The member firm will contact you directly to discuss the details further. If you wish to send an assignment to a specific firm, please indicate their firm name in the below form field labeled 'I-ENG-A MEMBER FIRM NAME'. The field names in red indicate the required fields. Call (844) 217-6975 if you require any assistance.

Individual Requesting Service --

Name *:

Title :

Email Address *:

Phone *: Ext:

Cell/Mobile:

Fax :

Company Name:

Company Address:

City

State

Zip

Contact During:

Normal Hours 9am-5pm EST

Extended Hours 8am-10pm EST

Assignments specific

Please send assignment:

To closest I-ENG-A firm

To firm indicated below.

Send assignment to

Priority Level:

Assignment Type:

Traffic Accident Reconstruction

Construction Defect

Bodily Injury / Slip and Fall

Property and Structural

Mechanical & Electrical

Fire Investigation

Vehicle Fire Investigation

Indoor Air Quality / Microbial

Other

Description of Occurrence and Special Instructions:

Claim/Assignment Insured/Client Contact Information

Claim #:

Date of Loss:

Your Client/Insured Contact Name(s):

Insured Company Name:

Insured Address:

City:

State:

Zip:

Phone#

Client Cell/Mobile:

Property/Evidence Information (If Different From Insured Address/Location)

Name of Location(s) of occurrence or property/evidence:

Contact Name:

Contact Phone:

Occurrence/Evidence/Property Address:

City:

State:

Zip:

Invoicing Information:

Contact/Department:

Company:

Address:

City

State:

Zip:

INFO

Please complete this Assignment Form as best you can. Minimal information to create an assignment is your name, phone number and/or email address. When submitted between 9am-5pm EST we will be in contact within 1 hour to complete your request unless you request extended hours.