Policy Search Request - Black Pine Services

Law Firm

Law Firm Address (street address)

Street Address Line 2

City/State

Postal/Zip

Requestor Name

Requestor Phone Number

Requestor Email

Any additional email address for results to be sent to

What type of research do you need?

Liability Limits

Policy Existence

Asset Search

Standalone Umbrella

Would you like to purchase the umbrella if found?

Yes

No

Plaintiff's Name and Case #

Date of Loss

Is this currently in litigation?

Yes

No

What is the date this case was filed?

Is the research on a policy covering an individual (personal policy) or commercial entity (business)?

Personal Auto

Commercial Auto

Homeowners/Renters

Commercial General Liability

How quickly do you need the results?

Standard Processing

2 Business Days

12 Business Hours

6 Business Hours

(Commercial Research) Information Requested

Policy Limits

Policy Number

UM/UIM Limits

Defendant's Name

Date of Birth

Address (Street Address)

Street Address Line 2

City/State

Postal/Zip

Defendant's Phone Number

Driver's License Number

Vehicle Make and Model

VIN #

Insurance Carrier (Level 2 Carriers 7-10 business days / Level 3 may take up to 10-24 business days)

Policy Number

Claim Number

Adjuster's First Name

Adjuster's Last Name

Adjuster's Phone Number

Supporting Files

Supporting Notes

Signature

Policy Search Form

Policy Search Request Form

Requestor Information

Request type

(Please note: Hours of operation are 9am - 6pm Central Standard Time Monday - Friday. All processing times are subject to Four Pillars Research's standard hours of operation)

Defendants Information

Insurance Information

Additional Information

Consent