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NEW CUSTOMER ASSIGNMENT

New Customer Assignment

If you’re not a Horsemen Investigations customer and you would like to submit your first assignment to us, please fill-out the New Customer Assignment Form below and a sales representative will contact you shortly.

INVESTIGATION ASSIGNMENT

Due Date *

Rush Job *

No
Yes

Services *

Surveillance - Manned
Surveillance - Unmanned
Interview(s)
Scene Canvass
Background Check
Social Media Check
Document Retrieval/Service
Medical Canvass
Other

REQUESTOR

Name *

First

Last

Company *

Requestor Phone *

Requestor Email *

Email

Confirm Email

Branch

Insured

Claim # *

Contact at Insured

D.O.I.

Insured Phone

CLAIMANT

Name *

First

Last

Claimant Phone

Claimant Address

Address Line 1

City

State

Zip Code

Prior Address

SSN

D.O.B.

Occupation

DESCRIPTION

Sex

Hair

Weight

Eyes

Height

Children

Race

Marital Status

Distinguishing Features

Vehicle Model/Color

Vehicle Plate

Drivers License

INJURY

Please note left or right

Back

Hand

Elbow

Wrist

Stress

Knee

Foot

Shoulder

Arm

Neck

Hip

Ankle

Eye

Face

Groin

Other

Injury Notes

ADDITIONAL INFORMATION

Client Requests

Supporting Documents

Click or drag files to this area to upload. You can upload up to 4 files.

Verify You're Human *

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P.I. License Numbers:
CA (#17753, #24911); NV (#1398);
HI (#PDA-883); AZ (#1555433)
TX (#A15800); WA (#2766);
OR (#033923); NM (#PI3654)