| Common Information |
| Order Type |
Signed Authorization |
| Case Number |
ABD987654 |
| Plaintiff |
Smith |
| Defendant |
Johnson |
| Records Subject |
Smith Wesson |
| DOB |
|
| SSN |
|
| AKA |
|
|
| Party 1 of 4 |
| Firm |
CJ Law |
| Roles |
Ordering Party, Send Records |
| Address |
126333 South Street |
| City |
Bakersfield |
| State |
CA |
| Zip |
98765 |
| Phone |
(123) 123-1234 |
| Fax |
|
| Email |
|
| Contact Person |
Greg Smith |
|
| Party 2 of 4 |
| Firm |
State Farm Insurance Company |
| Roles |
Primary Billing |
| Address |
PO BOX 106171 |
| City |
Atlanta, GA 30348 |
| State |
|
| Zip |
|
| Phone |
(408) 842-4548 |
| Fax |
|
| Email |
|
| Contact Person |
Patrick Griffith |
|
| Party 3 of 4 |
| Firm |
Aaron, Riechert, Carpol & Riffle, APC |
| Roles |
Represent Consumer |
| Address |
333 Twin Dolphin Drive, Suite 350 |
| City |
Redwood City, CA 94065 |
| State |
|
| Zip |
|
| Phone |
(650) 368-4662 |
| Fax |
(650) 367-8531 |
| Email |
|
| Contact Person |
Juliette D. Nguyen, Esq. |
|
| Party 4 of 4 |
| Firm |
State Farm Insurance Company |
| Roles |
|
| Address |
PO Box 106171 |
| City |
Atlanta, GA 30348-6171 |
| State |
|
| Zip |
|
| Phone |
(949) 553-4670 |
| Fax |
|
| Email |
|
| Contact Person |
Kathy Hernandez |
|
| Location 1 of 2 |
| Client Reference # |
AfsdaFa |
| Name |
Kaiser Permanente |
| Address |
3558 Round Barn Blvd., Ste 112 |
| City |
Santa Rosa, CA 95403 |
| State |
|
| Zip |
|
| Phone |
(707) 571-3770 |
| Fax |
|
| Email |
|
| Due Date |
|
| Types |
Car Payment |
| Specifics |
|
| Names |
|
|
| Location 2 of 2 |
| Client Reference # |
|
| Name |
Kaiser Permanente |
| Address |
401 Bicentennial Way |
| City |
Santa Rosa, CA 95407 |
| State |
|
| Zip |
|
| Phone |
(707) 566-5560 |
| Fax |
|
| Email |
|
| Due Date |
5/30/2024 |
| Types |
Payroll, Rads |
| Specifics |
|
| Names |
|