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Thank you for submitting your assignment online. Your information will be submitted to our office. One of our Origin and Cause Investigators will contact you soon.

Request Type *

Firm Name *

Contact Name *

Work Phone *

Fax

Contact Name Last *

Cell Phone

Email *

Mailing Address

Street Address *

City *

ZIP Code *

Address Line 2 *

State *

Are you the adjuster? *

Yes No

Adjuster Name *

Adjuster Phone Number *

Adjuster Email Address *

Billing Information

Billing Address is same as above *

Yes No

Billing Address

Billing Street Address *

Street address *

Billing City *

City *

Billing ZIP Code *

ZIP Code *

Billing Address Line 2 *

Address Line 2 *

Billing State *

State

Billing Phone *

Billing Email Address *

Loss Information

Claim Number *

Loss Type *

Policy Number

Date of Loss *

Provide Specific Details of Loss *

Loss Address

Loss Street Address *

Street address *

Loss City *

City *

Loss ZIP Code *

ZIP Code *

Loss Address Line 2 *

Address Line 2 *

Loss State *

State

About the Insured

Insured Name *

The insured is the *

Owner Tenant Other

The insured is by other *

Insured Address is same as Loss Address above *

Yes No

Insured Address

Insured Street Address *

Street address *

Insured City *

City *

Insured ZIP Code *

ZIP Code *

Insured Address Line 2 *

Address Line 2 *

Insured State *

State

Insured Primary Phone *

Insured Alternate Phone

Insured Email

Attorney Info

Attorney is the same as Primary Contact Above *

Yes No

Attorny Firm Name *

Attorney Contact Name *

Attorney Contact Last Name *

Attorney Phone *

Attorney Email *

Attorney Address

Attorney Street Address *

Street address *

Attorney City *

City *

Attorney ZIP Code *

ZIP Code *

Attorney Address Line 2 *

Address Line 2 *

Attorney State *

State

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Goodson Engineering is a leading provider of forensic engineering and fire investigation services. Based in Denton, TX the team at Goodson Engineering brings more than 30 years in business to clients across the United States.

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