Nick James Investigations, Inc.
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Services Requested
Surveillance
Location/Skiptrace
Resurveillance
Hospital Check
Background Check
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Special Investigation
Asset Check
Pre-Employment Screen
Client Information
First Name:
Last Name:
Company:
Email:
Address:
Suite #:
City:
State:
Zip Code:
Country:
Phone:
Date of loss:
Your File Number:
Assured:
Subject Information
Workers Comp
Liability Claim
Auto Claim
Other
First Name:
Last Name:
Last Address:
Appartment #:
City:
State:
Zip Code:
Date Of Birth:
Height:
Weight:
Race:
Sex:
Male
Female
DL Number:
SSN:
Spouse:
Children:
Occupation:
Employer:
Employer Address:
Employer Phone:
Vehicle:
Year:
Tag Number:
Injury:
Restrictions:
Total Days Requested
(or) Authorized Amount
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Additional Information
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