ASSIGN A CASE

Insurance Investigation

Private Investigation


If you are serious about your results, we are your finest choice.




FULLY-LICENSED

Submit New Private Investigation Assignment

If you do not wish to use this form, you can you can email your assignment to us instead. Be advised that our forms are typically much more detailed than standard Acord and other forms.
* The more information you provide, the better we can achieve your objectives *

Your Information
Bill to

,

,

,

City , State Zip

Phone , Xt # , Fax , Cell , Email


Primaty Objective(s)

, ,

, Venue (if litigated): , Civil/Criminal:

, ,


Target Information

, , ,

Known Identifiers

, , , Country of Origin ,

SS# , CDL , ,

, Hair Color: , Body Type:

Last Known Address:

, Unit#

City , State Zip

Phone , Cell , Email

Last Known Employer:

,

, Unit#

City , State Zip

Phone , Fax , Work Email

Supervisor's Name , Xt #

Vehicle Information:

, , , , License Plate #

VIN


Assignment/Case Objectives


Activity Checks Alimony Payments Arson Investigation Assets Check Background Checks
Child Support Civil Litigation Competitive Intelligence Counter-Surveillance
Court Appearance Criminal Litigation Diagram Prep Document Retrieval Employee Theft
Fraud Investigation Infidelity Lost Love Medical Fraud/Malpractice Missing Person
Nanny Cams Notary Assignment Process Service Skip-Trace Surveillance
Target Tracking (GPS, drones) Undercover Operation Witness Location Other Activity


Building Permits/Plans Certified Court/Legal Records Coroner's Report Death Certificate
Fire Reports Housing Violations Police Reports Trash Examination Other Documents


Photographs Only Video Only Both Photographs and Video
Injury Verification Residence Verification Target Activity Target Associations
Vehicle Damage Vehicle Identifiers Property Damage Scene Investigation Other Images


Colleagues Involved Parties Neighbors Relatives Witnesses Other Statements

Yes No


Cc Report to (if appl)
Bill to

,

,

,

City , State Zip

Phone , Xt # , Fax , Cell , Email


* Finalize *

Click the Print button and "change" printer type to Save as PDF option. Save the PDF of your completed request in your case file, then email the new assignment as a PDF attachment from your hard drive. If you don't have a PDF printer option, you can simply print out a paper copy and submit the request by fax.


"We appreciate your business!"

Note: Although we will invoice businesses, any investigation requested by a private person must be paid for in advance by Cashier's Check. No exceptions. We will provide a quote after a free initial consultation.


J. Koerner Investigations
P.O. Box 4186
San Dimas, CA 91773
Tel: (909) 225-5448
Fax: (909) 267-9760