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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 assignment unless otherwise directed. The member firm will contact you directly to confirm receipt of the assignment. 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'. You may call (800) 523-3680 to confirm receipt of your assignment, The field names in RED indicate the required fields. We would appreciate complete details by filling out the entireorm, if you require assistance providing details simply fill out the required fields (name and phone or email) we will contact you to complete the assignment process.


Individual Requesting Service --
Your Name: Title:
Company Name:
Company Address:
City: State: Zip:
Your e-mail: Cell/Mobile#:
Your Phone#: Ext:
**Please Use 1234567890 Format for all Phone Numbers.
 Your FAX#:
Contact During Normal Hours 9am-5pm EST Contact During Extended Hours 8am-10pm EST

Assignment Specifics --
Please send assignment to closest I-ENG-A firm OR ->> Please send assignment to firm indicated below.
Send Assignment to: OR Choose Firm:

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:
Client Phone# Ext: 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: Ext:
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.