Investigation Intake Form Select Case Type Choose the type of investigation you need ⚖️ Liability Personal injury & liability claims 🦺 Worker's Comp Workplace injury investigations 📋 Disability Disability claim investigations 🚚 Cargo Cargo theft & transport claims 🔍 Other 🆗 Plate Check Re-Open Case 📂 Re-Open Case enabled. You'll need to enter the MIG# on the next page. Continue → Case Information Enter the basic case details Assignment Date: 🚨 Rush Assignment Re-Opening MIG Case # * Claim Number * Date of Loss * Assignment Due Date Insured Name Normal turnaround time is within 30 days. Assignments due within 14 days of assignment date are considered rush. A 20% Rush fee will be added for Rush Cases. Plate Check Details Plate Number * Plate State * -- Select State -- ALAKAZAR CACOCTDE DCFLGAHI IDILINIA KSKYLAME MDMAMIMN MSMOMTNE NVNHNJNM NYNCNDOH OKORPAPR RISCSDTN TXUTVTVA WAWVWIWY ← Back Continue → Subject Information Please provide as much information as possible about the subject(s). The more details you provide, the greater our chances of successfully locating and identifying them. Subject 1 Primary First Name * Middle Name Last Name * Unknown Subject Date of Birth SSN Sex Select... Male Female Spouse / Relative Name + Add Physical Description Race / Ethnicity -- Select -- Asian Black Hispanic Middle Eastern White Unknown Height Weight Hair Color -- Select -- Bald Black Blonde Brown White Other Unknown Eye Color -- Select -- Amber Blue Brown Gray Green Hazel Unknown Distinguishing Marks Subject Address Information Street Address Apt # City State Zip Subject's Phone Subject's Email DL State Driver's License # Known Social Media i Additional Information + Add Another Subject (1/4) ← Back Continue → Supporting Documents Help us investigate more effectively by uploading relevant documents Documents to Include If available, please upload the following documents, as this information will assist us in conducting a thorough and effective review of your case: 🚗 AccidentReports 💳 Driver'sLicense 👤 Photos ofSubject 📷 ScenePhotos 🏥 MedicalRecords 📄 PoliceReports 📎 Click to select files or drag and drop PDF, Word, Excel, Images (Max 5 files, 10MB total) ← Back Continue → Vehicle Information Enter vehicle and accident details if applicable Vehicle Year Make Model Plate Number VIN # Vehicle Color Subject's Insurance Carrier Loss Location Vehicle involved in loss Vehicle was totaled ← Back Continue → Employer Information Enter the subject's employment details if known Subject's Employer Employer Phone Employer Street Address Employer City Employer State Employer Zip ← Back Continue → Injury Information Enter details about alleged injuries and medical treatment Alleged Injury Emergency Treatment at Treating Physician Medical Providers & Upcoming Appointments ← Back Continue → Services Requested Select services for each subject Subject 1 Primary Initial Investigation (3-Day Surv / IPR / Background) i Internet Investigations Internet Presence Review i Internet Presence Audit i Internet Presence Monitoring i Internet Scene Canvass i Select Days... 30 Days 60 Days 90 Days Jury Internet Voir Dire i Surveillance Surveillance Days i Recurring Surveillance i SIU Services Cargo/Vehicle/Trailer Theft i Fraud Referral/Review i Record/Video Retrieval i Scene Investigation i Statements/Interviews/EUO i Investigative Services Background Check i Activity Check i Alive & Well Check i Asset/Income Check i Decedent Check i Pre-Employment Check i Pharmacy & Medical Canvass i Skip Trace i MVR Only i Initial Investigation (3-Day Surv / IPR / Background) i Internet Investigations Internet Presence Review i Internet Presence Audit i Internet Presence Monitoring i Internet Scene Canvass i Select Days... 30 Days 60 Days 90 Days Jury Internet Voir Dire i Surveillance Surveillance Days i Recurring Surveillance i SIU Services Cargo/Vehicle/Trailer Theft i Fraud Referral/Review i Record/Video Retrieval i Scene Investigation i Statements/Interviews/EUO i Investigative Services Background Check i Activity Check i Alive & Well Check i Asset/Income Check i Decedent Check i Pre-Employment Check i Pharmacy & Medical Canvass i Skip Trace i MVR Only i Additional Instructions ← Back Continue → Client Information Enter the referring client and contact details Company Information Mohave Transportation Insurance Company Company Name * Insured / Location -- Select -- AAA Cooper Transportation Swift Transportation Knight Transportation EMA Risk Services Abilene Midwest Express US Xpress Barr-Nunn Transportation Other Insured / Location Name * Contact Information First Name * Last Name * Email * Phone * + Add Secondary Contact Secondary Contact (CC on Reports) First Name Last Name Email Phone ← Back Submit Request
