Experienced Private Investigators You Can Trust Corporate Headquarters 200 S. Wing St. #708,Northville, MI 48167 Phone (888) 489-9989 Email request@cxipi.com Service Request Form "*" indicates required fields Company/Firm Name Handler/Attorney Name:* Phone/Extension:*Email:* Claim#: Budget: Best Time to Reach You Hours : Minutes Claimant/Subject Name: Date of Birth: MM slash DD slash YYYY SS#: Gender: Description: Date of Loss: MM slash DD slash YYYY Address: Phone:Allegations/Injuries: Medical Appointment (IME) Date & Time: Legal Appointment (DEP & EUO) Date & Time: Social Media Request and/or Medical Canvass Request:(Provide any known information relative to the claimant’s digital footprint here in your specific instructions. i.e., any associated e-mail(s), social media usernames, associated URL’s, etc.) Specific Instructions: Assignment Type (Check All That Apply) Surveillance Unmanned Camera Surveillance Assigned Claims Investigations Social Media Canvass & Forensic Collection of Web Data Medical Canvass S.I.U. Investigation Background Investigations CommentsThis field is for validation purposes and should be left unchanged.
