Southern California Office: (562) 697-6747 Fax: (562) 694-8530 info@excaliberinvestigations.com www.excaliberinvestgations.com

Excaliber Investigations - Request for Investigation - Property and Casualty Online Form

Northern California Office: (209) 835-6413 Fax: (562) 694-8530 info@excaliberinvestigations.com www.excaliberinvestgations.com

Requestor:

Phone:

E-mail:

Company:

Copy To:

Bill To:

Claim #:

File #:

Date of Loss:

Court Case Name:

Court Case #:

Type of Loss:

Investigation Desired:

Locate:

Photo:

Vechicle

Scene Investigation

Statementize:

Background:

Special Investigation

Process Service:

Clinic Inspection

Insured's Name:

Residence:

Phone:

Social Security #:

DL #:

DOB:

Vechicle:

Other:

Planiff's/Claimant's/Witness' Name:

Residence:

Phone:

Social Security #:

DL #:

DOB:

Vechicle:

Other:

Surveillance at:

Number of Days:

Weekday

0 1 2 3 4 5

Weekend

0 1 2

Special Instructions:

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