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CheckMate Investigations LLC

Client Assignment Form

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All information submitted electronically is confidential and will be processed discreetly.

File number :
Date of Loss :
Subject(s)/Claimant(s) :
Subject(s) Current Address
Subject(s) Phone # :
2nd Address(s):
Social Security Number :
Full Physical Description :
Race :	Caucasian
	African American
	Latin
	Asian
	Other
D.O.B.
Gender :
Type of Disabling Injury :
Attorney Represented?
Employer/ Last Occupation:
Doctor/Medical Offices:
Hobbies or Places of Interest?
All Vehicles :
Client :
Address :
Telephone :
Fax #:
Please Explain the Purpose of Investigation/Surveillance:
Hours Allocated :
Was there ever any Surveillance or Investigations done prior?
File Completion Date :
Your File #
Type of Surveillance or Investigation :

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Privacy Policy: All information submitted on this page is confidential and will not be viewed by outside sources. The owner of CheckMate Investigations LLC and its affliates will view this document only. After the assignment sheet has been completed and sent, a representative of CheckMate Investigations will contact you within 24 hours. Following, a contract will be presented so the agreement can be completed.

© 2004-2007 CheckMate Investigations LLC P.O. Box 825 Bethel, CT 06801
203.743.6455-all rights reserved-

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