Insurance Fraud Case
Stealth Private Investigations, Inc. Fort Myers (239) 464-1815 * Sarasota (941) 870-1965 * Orlando (321) 285-7656 Miami (305) 590-8453 *
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Client:
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Phone:
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Company:
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Fax:
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Address:
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City:
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State:
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Zip:
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Email:
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Updates of case activity:
Verbal
Email
Both
Fax
No
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Objectives and Instructions:
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Turnaround:
Standard 2 Weeks
Rush
Claim Number:
Insured:
DOL:
Type of Claim:
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Subject:
Phone:
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Address:
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City:
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State:
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Zip:
Cell::
SS#:
DOB:
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Race:
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Sex:
Male
Female
Eyes:
Height:
Weight:
Visible marks:
Occupation:
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Injuries:
Restrictions:
Work Status:
Subject Information- Vehicle:
Yes
N/A
Color:
Make:
Model:
Year:
Tag #/state:
Doctor’s name:
Doctor’s address:
City:
State:
Zip:
Known medical appointments:
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How did you hear about us:
Google.com
Yahoo.com
Yellowpages.com
Claimpages.com
ION.com
Other
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I agree to the terms of the contract:
No
Yes
More info about this case::
Please click on the Submit button to submit the form details.
Florida Private Investigations Agency serving South Florida: Orlando, Tampa, Sarasota, Fort Myers, Cape Coral, Naples, Miami, Fort Lauderdale
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