• First Name:
• Street Address:
• Phone:

• Last Name:
• City:
• Extension:

• Title:
• State:
-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist 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


• Email:

• Company / Organization:
• Zip Code:
• Confirm Email:

• Comments / Additional Information:

• Claim Number:

• Date Of Loss:

• Claim Type:
-- Select -- Workers Comp. Disability FMLA Abuse Auto Liability Medical Liability Residency Verification Property Liability Other

• Prior Investigation:
-- Select -- Yes No

• Insured Name:
• Street Address:

• Insured Contact:
• City:

• Title:
• State:
-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist 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

• Phone Number:
• Zip Code:

• Investigation Requested #1:
-- Select -- Surveillance Activity Check Alive & Well Check Skip Trace/Locate Interviews & Statements Records Research Process Service Background Investigation Social Media Search Widow/Dependent Check Undercover Operations AOE/COE Other


• Investigation Requested #2:
-- Select -- Surveillance Activity Check Alive & Well Check Skip Trace/Locate Interviews & Statements Records Research Process Service Background Investigation Social Media Search Widow/Dependent Check Undercover Operations AOE/COE Other

• Priority Level #1:
-- Select -- Standard Rush Date Specific


• Priority Level #2:
-- Select -- Standard Rush Date Specific

• Trial / Hearing Date


• Investigation Requested #3:
-- Select -- Surveillance Activity Check Alive & Well Check Skip Trace/Locate Interviews & Statements Records Research Process Service Background Investigation Social Media Search Widow/Dependent Check Undercover Operations AOE/COE Other

• Reporting Preference:
-- Select -- Email (Preferred) US Mail Phone Other


• Priority Level #3:
-- Select -- Standard Rush Date Specific

• First Name:
• Street Address:
• Home Phone:
• Date of Birth:
• Gender:
-- Select -- Male Female Unknown



• Height:
-- Select -- 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" 6'5" 6'6" 6'7" 6'8"


• Photo Available:
-- Select -- Yes No


• Marital Status:
-- Select -- Single Married Divorced


• Occupation:
• Other known activities:
• Upcoming medical appointments:
-- Select -- Yes No

• Claimant Attending Therapy:
-- Select -- Yes No

• Drivers License #:

• Middle Name:
• City:
• Cell Phone:
• Social Security Number:
• Race:
-- Select -- White/Caucasian African American Hispanic/Latino Asian/Oriental Middle Eastern/Indian Other



• Weight (Pounds):
• Other notable features: (Glasses, Tattoos, Complexion, Build, etc.)



• Spouse / Other:
• Hobbies / Interests:











• Date / Time:
• Date / Time:
• Issuing State:
-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist 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 Other

• Last Name:
• State:
-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist 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

The more info you can assist us in compiling will increase our odds of uncovering more information relevant to the claimant via our Social Media Search, Background Search & Proprietary Records Database.




• Hair Color:






• Dependents / Other:


What hobbies or interest are you aware of the claimant being involved in? Do they fish/hunt? Ride motorcycles? Active with their children's sports teams? Is there a birthday/anniversary in the family coming up? These details provide more options when preparing our investigation strategy.

• Location:
• Location:

Are there any upcoming appointments the claimant may be attending? IME, Medical, PT. These are excellent opportunities to identify the claimant in a different atmosphere. Our experience has found claimant activity levels to be significantly higher on these days.

• Aliases / AKA / Other
• Zip Code:











• Hair Style / Length:






• Names / Dates of Birth:














• Claimant Doctor:


• Claimants Attorney:

• Known Vehicles (Make, Model, Year, Color, etc.):