SECURE DOCUMENT UPLOAD

 

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Client Contact Information (Referring Party)
First Name* (required)
Last Name*
Company/Law Firm Name 
Email

 
Phone*

 
Claimant Information 
 Claimant First Name*
Claimant Last Name*
   
Claim Information 
Claim #*  Type of Claim  
Comments
 
Documents to Upload
  TIP:  Compress multiple small files into a Zip file for easy uploading!
Document #1
Document #2
Document #3
Document #4
 
     
  Please be patient  - Depending on the size of the files, it may take longer to upload.

Evaluations Plus, Inc. - 425 W. Huron Street, Milford, MI 48381
(248) 478-4055 phone - (248) 478-2660 fax  - www.evalplusinc.com