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Submit A Case
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Investigation Services
Career Opportunities
(888) 734-7660
Submit A Case
SERVICE REQUEST FORM
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Client Information
Company/Firm Name
Handler/Attorney Name:
*
Email
*
Budget:
Coverage Type:
Phone/Extension:
Claim#:
*
Best Time to Reach You
Subject Information
Claimant/Subject Name:
Last 4 of SS#
Date of Birth:
Gender:
Subject Description:
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone:
Allegations/Injuries:
Legal Appointment (DEP & EUO) Date & Time:
Date of Loss:
Medical Appointment (IME) Date & Time:
Social Media Request and/or Medical Canvass Request:
(Provide any known information relative to the claimant’s digital footprint here in your specific instructions. i.e., any associated e-mail(s), social media usernames, associated URL’s, etc.)
Specific Instructions:
Assignment Type (Check All That Apply)
Surveillance
Unmanned Camera Surveillance
Assigned Claims Investigations
Social Media Canvas
Medical Canvas
S.I.U. Investigation
Background Investigations
Process Serve
Submit