Completeinv.com case submission

Authorization of Investigation

Case Title:

Insured's Name:

Date of Trial:

Contact Insured:

Yes No

Financial Authority

Names of Contacts:

DVD or VHS:

Contact Phone :

Type of Investigations (check if applicable)

Activities and Background Investigation- Public records search and background profiling for leads as to
past and current activities; discreet neighborhood inquiries, interview of insured if required, contacts with
local police departments, court houses and other informants. Residential spot checks and complete description
of residence's location, its surroundings, and obtain all vehicle information according to client's instructions.
Surveillance days of surveillance-Obtain evidence and gather information regarding subject's daily activities.
Public Records Search-In county where subject resides. Contacting local courthouses and law enforcement agencies.

Driving Record/ Vehicle Registration

Internal Business Investigation

Interviews / Witness Location

Auto Theft Investigation

Purpose of Investigation

To your knowledge, has this subject been previously investigated? Yes No

Special Instructions:

Subjects Information

Name:

Social Security# :

Date of Birth:

Driver's License:

Address:

Gender:

City::

Race::

State:

Height/Weight:

Zip Code:

Description of Loss::

Phone:

Date of Injury:

Children:

Represented:

Spouse Name:

Would you like your attorney to receive a copy of this report? Yes No

If Yes:

Attorney Name:		Law Firm:
Address:		Contact:
City:		Phone:
State & Zip:		Email:
Special Instructions:

Your Authorization:

Your Name: (Required)

Your Company Name:

Your File #:

Your Address:

Date:

City:

Your Telephone: (Required)

State & Zip:

Your Fax:

Your Email: (Required)

Would you like a copy of the report emailed to you upon completion? Yes No

By clicking submit on this form authorizes Complete Investigations, LLC (CI) to investigate the detailed information provided above, and understands and agrees that by authorizing CI to perform the requested services holds the agreed to payment within 20 days from the invoice date.