166 Hargraves Drive

Austin, TX, 78737

714.960.9600

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Investigation Assignment Form

Client Information

Please provide the information below for yourself and any secondary contact at your firm.

Client Name

First Name

Last Name

Firm Name

FIrm Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone

Country

(###)

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Mobile Phone

Country

(###)

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Secondary Contact Name

Secondary Contact Email

Office Phone

(###)

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Mobile Phone

(###)

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Assignment Information

Please be as complete as possible in providing the requested assignment information. This will allow us to quickly asses and respond to your service request. You may attach documents to supplement the information provided in this section.

Your File / Claim Number

Date of Loss

YYYY

Loss Location

Address / City / State / Zip

Loss Description

Insured / Defendant Name

Budget (if applicable):

Type of Investigation

Assignment Due Date

YYYY

Assignment Instructions

Reporting / Invoicing Information

Please indicate who is authorized to receive Reports and Enclosures from our firm during this assignment.

Report to Name

(If different from the client making this assignment)

First Name

Last Name

Report to Email

Report CC to

First Name

Last Name

Report CC Email

Mailing Address

(If different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Invoice To Name

First Name

Last Name

Invoice To Email

Additional / Special Invoicing Instructions

Primary Party / Insured Information

Defendant / Insured Name

First Name

Last Name

Defendant / Insured Phone

(###)

###

####

Defendant / Insured Mobile Phone

(###)

###

####

Defendant / Insured Email

Defendant / Insured DOB

Defendant / Insured DL No. & State

Defendant / Insured Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Defendant / Insured Prior Addresses

Defendant / Insured Physical Description

Defendant / Insured Vehicle Description

Primary Party Employer Information

Company Name

Company Contact Person

First Name

Last Name

Company Contact Telephone

(###)

###

####

Company Contact Email

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Claimant / Plaintiff Information

Name

First Name

Last Name

Home Phone

(###)

###

####

Mobile Phone

(###)

###

####

Work Phone

(###)

###

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Date of Birth

DL No. & State of Issuance

SSN

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Prior Addresses

Alleged Injuries

Claimant / Plaintiff Description

Height

Weight

Eye Color

Hair Color

Vehicle Descriptions

Represented by Counsel

Yes

Counsel Name

First Name

Last Name

Witness Information

Witness 1 Name

First Name

Last Name

Witness 1 Phone

(###)

###

####

Witness 1 Email

Witness 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Witness 2 Name

First Name

Last Name

Witness 2 Phone

(###)

###

####

Witness 2 Email

Witness 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Documents

If you have any other documents which would assist in our investigation, please attach here.

Other Information / Comments

SUBMIT CONSULTING ASSIGNMENT

Name

First Name

Last Name

Entity Name

Entity Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Phone

(###)

###

####

Cell Phone

(###)

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Assignment Type

Assignment Details

“It is with great pleasure that I recommend Matthew Brady and the entire crew at Quaere, Inc., should you require ethical, proficient, and professional investigative services to defend your client’s interests. Mr. Brady has been providing investigative services to Hyundai for nearly 30 years and Quaere, Inc. routinely handles high exposure product liability; consumer; labor & employment; and sensitive internal matters with outstanding results. This team of investigators obtains the critically important information necessary for counsel to make informed decisions in their highest exposure and most sensitive cases”
Jamison E. Power, Esquire - Senior Counsel - Hyundai Motor America

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