Continental Court Reporters, Inc.

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(800) 779-6981

Order Records

Order Records with Continential Court Reporters

Please fill out all the information below. Fields with a * means it is required information.

If you need your order sent to you on a RUSH basis, please contact us today to guarantee expedited delivery. Otherwise, the order you place with this online form will be produced via regular turnaround (8-10 business days).

Your Law Firm Information

Law Firm Name:

Law Firm Address:

Law Firm City:

Law Firm State:

Law Firm Zip:

Law Firm Phone:

Attorney Name:

State Bar Number:

Representing:

Contact Information

Your Name:

Your E-mail:

Contact Phone#:

Direct Questions Form

Please choose the form of direct questions required.

AdmissibleInadmissible with AffidavitAuthorization with Affidavit

Case Information

Style of the Case:

Cause No.:

Court:

County of:

Depo/Trial Date:

Attorneys of Record

Please list all attorneys of record in this case.

Attorney 1Who Represents:

Attorney 2Who Represents:

Attorney 3Who Represents:

Attorney 4Who Represents:

Attorney 5Who Represents:

Attorney 6Who Represents:

Attorney 7Who Represents:

Attorney 8Who Represents:

Attorney 9Who Represents:

Attorney 10Who Represents:

Your Records Order

Please fill out who you would like to order records of.

First Name:

Middle Name:

Last Name:

Social Security Number:

Date of Birth:

Other Identifying Information:

Type of Records Needed

Please Indicate what type of records you are ordering.

Medical RecordsBilling RecordsBilling Records (Proved Up)Radiological FilmsPersonnel RecordsPayroll RecordsPolice Records

Other Records:

Date of Records

Any and All DatesThe Following Dates Only:
FROM:
TO:

Affidavit of No Records

If no records are available, do you require an Affidavit of No Records?

YesNo

Records Locations

Please list all locations that would have the records you are ordering.

Location 1Location 2

Location 3Location 4

Location 5Location 6

Location 7Location 8

Location 9Location 10

Insurance Billing

Please indicate wheather we are to directly bill an insurance company.

Bill Insurance Company? YesNo

Insurance Company:

Adjuster/Supervisor:

Claim No.:

Billing Instructions:

Comments and Instructions

Comments and/or Special Instructions:

Attach Any Additional Documents

If you would like to send us additional documents for your records order, please upload the files from your computer. Your attachments cannot total to over 5 MB (5 Megabytes). PDF format or DOC format preferred.

Attach Notice:

Attach Notice:

Attach Notice:

Disclaimer

Please note that your records order is not officially placed with us until we contact you for confirmation. By filling out the form above, you understand that the records order is not guaranteed until it is confirmed by our records department, who will contact you at their soonest opportunity.

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