Claims Detective - Insurance Claims and Legal Defense Investigations

	New Claims Detective Assignment Rather Call Us? Hours: Monday through Friday 8:00 AM to 5:00 PM Central time. Call 1-800-324-5578 International +001-(312) 854-1826 Fax 1-888-777-5682 Support@ClaimsDetective.com



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Case Request
(Simply enter the available information. We will follow up with a confirmation)

Subject Information:

Name:
Address:
City, St, Zip:
Home Phone:
Cell Phone:
Date/Birth:
SS#:
D/L#:
Vehicle Type:
Owner:
Ins Carrier:
Employer:
Address:
City, St, Zip:
Phone:
Occupation:
Claim Information:
Claimant Atty:
Add/Phone:
Claim #/File#:
Assured:
Loss Date:
Location:
Injury:
Treated At:
ClaimsDetective Prior File Date?:
Requested Work:
	Background (Review of subject's history) Activities (neighborhood/business) Employment (past and present) Medical and Health Status Records Check (civil,criminal,financial) Subrogation (assets,income,employment) Financial History Fire (finances,background,criminal) Location Report (for missing persons) Pre-Employment Dependency (marital status, dep. Children) Surveillance (Video Documentation)

Type of Case:
Client Requesting Report:

Name:
Customer ID:
Company:
Email(required):
Phone:
Fax:
Address:
City, St, Zip:
Comments:

Comments: