THE NEXT STEP IN THE RIGHT DIRECTION

If you would like to hire Elite Investigations, please fill out and submit the online form below. You are also welcome to print a PDF version of this form (below), fill in the required information by hand and fax or mail it to us. Of course, we are always willing and available to obtain any information from you over the telephone, if you desire (Toll free: 866-GO ELITE or 702-897-8473).

Confidentiality: Elite Investigations agrees not to release or otherwise divulge any information supplied herein, and that all information given shall be held confidential.

Required fields are denoted with an asterisk (*).

COMPANY/CONTACT INFORMATION

Name*:
Company*:
Telephone*:
Fax:
Address:
City:
State:
ZIP:
Email address*:
Client claim number:
Budget:

CLAIMANT/SUBJECT

Name:
DOB/Age:
Hair:
Weight:
Height:
Address:
City:
State:
ZIP:
Telephone:
Social security number:
Occupation:
DOI:
Injury:
Restrictions:
Is claimant working?: Yes
No
Does the claimant have modified duties?: Yes
No
Work schedule:
Days off:
Can you provide a photo?: Yes
No

INSURED/EMPLOYER

Contact:
Address:
City:
State:
ZIP:
Phone:
May we contact?: Yes
No

TYPE OF SERVICE

Surveillance
AOE/COE
Subrogation
Liability
Other:

Number of days/hours:

APPOINTMENT

Day/date:
Time:
Doctor:
Location:

REPORT/VIDEO HANDLING

Email report to client?: Yes
No
Email invoice to client?: Yes
No
Mail hard copies to client?: Yes
No
Video format:

Special instructions:

PRINTABLE FORM

If you would prefer, you can download/print this form. Please mail your completed form to Elite Investigations, Inc., 8170 S. Eastern Ave. #4-284, Las Vegas, NV 89123 or fax it to us at 702-270-8650.

Hire an Investigator
(pdf, 528kb)

©2006 Elite Investigations. 7435 S. Eastern Avenue, #5-284, Las Vegas, NV 89123.
866-GO ELITE (toll free), 702-897-8473, 702-270-8650 (fax). Nevada License No. 873.
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