Submit a New Assignment Contact Name:* Company Name: (If Applicable) Address:* United States Country E-mail:* Contact Phone:* – Preferred Method of Contact:* Email Phone Type of Case Submission: (Choose only the service you require)* Fire Loss Theft Surveillance/Private Investigation Background Check Other Claim Number:* Date of Loss:* / / Insured/Claimant Name:* Address:* United States Country Contact E-mail:* Contact Phone:* – Type of Fire:* Residential Structure Fire Commercial Structure Fire Vehicle Fire Additional Information: (Optional) Loss Location:* United States Country Claim Number:* Date of Loss:* / / Insured/Claimant Name:* Address:* United States Country Contact E-mail:* Contact Phone:* – Type of Theft:* Automobile Other Additional Information: (Optional) Please Elaborate:* Theft Location:* United States Country Type of Surveillance:* Corporate Surveillance Personal/Private Surveillance Nature of Surveillance:* Person of Interest:* POI’s Date of Birth:* / / POI’s SSN:* General Description of POI:* Image of POI: Height:* Weight:* POI’s Home Address:* United States Country Business Address: (If Applicable) United States Country Vehicle Information: Nature of Surveillance:* Person of Interest:* POI’s Date of Birth:* / / POI’s SSN:* General Description of POI:* Image of POI: Height:* Weight:* POI’s Home Address:* United States Country POI’s Work Address:* United States Country Vehicle Information:* Person of Interest:* POI’s SSN:* POI’s Date of Birth:* / / POI’s Address:* United States Country Other Instructions: Please Give a Full Detailed Description of Your Case:* Budget Restrictions: (Optional) Please Email Me A Copy of this Form Submission Submit Should be Empty: