Client Information Firm Name Firm Address (City) Phone Fax Your Name Email Address Deposition Information Case Caption Attorney Attending Location Deponent Date/Time Billing Instructions Insurance Carrier or Third Party Insurance Adjuster or Contact Adjuster's/Third Party's Address Claim No. Submit to Platinum Options Please confirm my scheduling by phone. (Please allow 24 hours.) Conference room? Yes No Reporter? Yes No Videographer? Yes No Interpreter? Yes No Language Real-time? Yes No Internet Real-time? Yes No VideoConferencing? Yes No Computer/Laptop Link? Yes No # of hookups Other requests

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