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Research Technical Services, Ltd.

Serving the Insurance Industry







Audit Request Form

You must click SUBMIT to send us your request.

Remember to PRINT the page for your records.


INSURANCE COMPANY NAME: *
RTS ACCOUNT#: *
REQUESTOR'S NAME: *
POLICY #1: *
POLICY #2:
INSURED OR BUSINESS NAME: *
INSURED'S PHONE#:
STREET ADDRESS
CITY
STATE
ZIP CODE
PHYSICAL AUDIT ADDRESS
CITY
STATE
ZIP CODE
CONTACT'S NAME:
CONTACT'S PHONE:
TYPE?
DUE DATE :
ORDER DATE :
AGENT/AGENCY:
TELEPHONE:
POLICY TYPE : *
WORKERS COMP   
GENERAL LIABILITY   
GARAGE LIABILITY HAZ I   
GARAGE LIABILITY HAZ II   
COMMERCIAL AUTO   
OTHER (Please Specify)   
AUDIT TYPE : *
PHYSICAL   
SPECIAL (Documentation)   
TELEPHONE   
INTERIM (Specify Length)   
POLICY START DATE :
POLICY END DATE :
ESTIMATED EXPOSURE BY CLASS:
 CODE - - - - - -  CLASSIFICATION - - - - - - - - - - - AMOUNT (Payroll/Sales/Units)
OFFICER / OWNER - INCLUSION / EXCLUSION:
SPECIAL INSTRUCTIONS / CLAIMANT INFO:

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Research Technical Services Ltd.
A Company Expanding the Service Role



RTS Homepage  |  About Us  |  Contact Information  |  Services Information  |  Audit Services  |  Loss Control Services  |  Guest Sign-In  |  Inspection Order Form  |  Inspection Status  |  Audit Order Form  |  Audit Status  |  Current Job Openings  |  How To Apply  |  Employment Sign-In  |  Test Audit Package  |  Test Inspection Package  |  Calendar of Events  |  Download Files/Forms  |  Weekly Bulletin  |  Websites of Interest



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