Hail Litigation Package Order Form

 
Information

First Name
Last Name
Title
Company Name
Billing Address
 
City
State
Zip + 4 +
Phone Number
Fax Number
E-mail Address

I wish to receive additional information about other WDT products and services.

*** Payment Note: You will receive an electronic invoice at the e-mail address provided above.***

Reference Information

The following information is provided in the Hail Litigation Package for your reference convenience.
Claim or File Number (optional)
Insured Name (optional)

Time Information

***Note: Each portion of a 24 hour period constitutes a single report.***
***Each adjacent portion of a 24 hour period is an additional charge.***

Beginning Date: Month: Day: Year:
Beginning Time: Timezone:
Ending Date: Month: Day: Year:
Ending Time:    

Location Information
Street Address
City
State
Zip + 4 +
Latitude (if known) (in decimal degrees)
Longitude (if known) (in decimal degrees)

Additional Information

Please enter any additional information or comments you would like to include.
If you know the exact time of the event, please enter it here.

 
 


 


 
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