If you have a new case for JAD, Inc., please fill out the form below and click Submit, and one of our qualified consultants will be assigned to you. Once your assignment is received, we will send you an acknowledgment letter noting the assigned consultant and rate information, and our consultant will call you to discuss the case. If at any time you have a question or concern, please do not hesitate to contact our office at 610-239-9900.

Items marked with an * are required fields

Date *
Your Company Name *
Your Name *
Address *
Phone *
Fax *
Email Address
Counsel Name
Counsel Address
Counsel Phone
Counsel Fax
   
Insured/Defendant Name *
Contact Name
Address *
Phone *
Loss Location
   
Claimant/Plaintiff Name
Contact
Address
Phone
   
Your Claim/File Number *
Date of Loss
Description of Loss *
Services Required *
   
 
 
     
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