Welcome to Settlement Plug™

Thank you for reaching out—we believe every case has value, and we’re here to make sure you maximize yours.
This quick form helps us understand your situation and kick‑start your claim evaluation.

Do not give any statements or communicate with the insurance company. Adjusters are trained to interpret your words in the insurer’s favor and may use your statements to justify a low-ball settlement offer. Please direct all communication to our mailing address or email.

Settlement Plug™ will get you paid.

Contact information: Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

We got you !

When you’ve finished answering all the questions, click the Submit button below to send us your information.

Then sit back, relax, and let’s get you paid

— The Settlement Plug™ Team.

Welcome to Settlement Plug™

Contact information: Contact information

Preferred Contact Method

Gender

Type of Claim

Have you provided the insurer or its attorney with a recorded statement or an Examination Under Oath (EUO)?

What was your DOL (Date of Loss)? Please enter the date of loss in the format MM/DD/YYYY.

Please provide the location of the incident or accident (street address, city, and/or general area).

Which insurance carrier is handling your claim?

What is the claim number or policy number for this matter? If you don’t have a claim number or need us to contact the insurance company and file the claim for you, simply enter “Please obtain for me.”

Who is the adjuster handling your claim? Please provide the adjuster’s name, phone number, and email address.

Are you currently employed?

How did you hear about Settlement Plug™?

Attach any supporting docs hereHelpful items include: 1) Police reports 2) Photos or videos 3) Insurance letters and correspondence 4) Medical records and correspondence 5) Estimates, invoices, or repair documents

Please acknowledge that you have read and hereby accept the above privacy policy regarding use of my personal information by typing your full legal name below

Date (MM/DD/YYYY)*

We got you !