Atlas Plumbing Forensics

Project Submission Form

To submit a project, please fill in the information below. Providing as much information as possible will help us to quickly process your inspection and may help us provide better information for subrogation determination. Once the form and part are received, we will email you a confirmation of the project request with a project number. Processing typically takes three to five business days after receipt of the item. After we have inspected the part, we will email you a report from a licensed forensic PE with our findings, invoice and an evidence disposition form.

*required

Date Submitted: *
Submitter's Claim/File Number: *
Submitter's Name: *
Submitter's Company: *
Submitter's Address: *
Submitter's Phone: *
Submitter's Alternate Phone:
Submitter's Email: *
Email for report to be returned to (if different than submitter's email):
Do you need assistance with shipping?:
Insured's Name: *
Insured's Address: *
Date of Loss: *
Claimant's Name (if different)
Loss Address (if different):
Type of Part Submitted: *
Part Manufacturer:
Part Model Number:
Part Serial Number:
Part Purchase/Install Date:
Who installed part?:
Was part supplied with an appliance or fixture?:
Where was the part purchased?:
Are scene photos available?:
Water pressure at installation location:
Is the water supply source city or well?:
Who removed the part?:
How was the part removed?:
Any recent plumbing problems or service work at loss address?:
Are there receipts for the product?:
Is the part to be returned or stored?:
Return address:
Special handling instructions:
Payment method: