Assign A Case to Blue Eagle

Blue Eagle Investigations, Inc. Case Assignment Form

Please fill out all applicable data and submit to Blue Eagle Investigations, Inc. We will respond within 24 hours.

Date mm/dd/yyyy	Type Of Claim Other
Claim #

Surveillance Activities Check Background Check	Employment Check Pre-Employment Screening Skip Trace/Locate	Recorded Statements Interviews/Interrogations Integrity Check	Asset Check Record Search Process Service
Other Explain
Deadline
Significant Dates

Claimant/Subject Data

Name
Alias
Street Address
City	ST Zip
DL #	DL ST DOB SSN
Home Phone #	Cell Phone # Other #
Spouse	Dependents
Description	Height Weight Hair Eyes
Other
Vehicles
Employer	Occupation
Street Address
City	ST Zip
Insured	Date Of Loss
Street Address
City	ST Zip
Alleged Injury
Treatment
Restrictions
Prior Investigation/ Surveillance?	If Yes - Results Dates
Special Instructions

Client Data
Authorized Limits $	Total number of days New Client (10% Discount!)
Company Name	Client Name
Mailing Address
City	ST Zip
Email Address
Client Ph	Fax # Other #
Referred By