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Submit an Assignment

Submit New Assignment

We’re excited to hear how we can assist you with your investigation needs.

Fill out the form below regarding the services you need and the information we need to fulfill your request.

Requested Completion Date *

Client Contact Information

Insurance Company / Law Firm Name *

Client Name *

First

Last

Client Address *

Address Line 1

Address Line 2

City

State

Zip Code

Client Phone *

Client Cell Phone

Client Email Address *

Is billing / invoice being sent to a different party? *

Yes
No

Party responsible for billing / invoice *

First

Last

Billing - Insurance Company / Law Firm Name *

Billing - Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing - Contact Phone *

Billing - Email Address *

Case Information

Claim Type *

Date of Loss

Your Claim # *

Other/File #

Insured Name *

Is the subject a Driver, Passenger or Pedestrian?

Brief Synopsis of Loss / Accident

Statement(s)

Statement(s)

Written
Recorded
Interview Only

Locate(s)

Locate(s)

Locate your client | Insured | Insured Driver | Former Employee
Make direct contact with your client | Insured Driver | Former Employee
Do not make direct contact

Background Investigations

Background Investigations

Full Background
Criminal Background Only

Social Media Investigations

Social Media Investigation

Social Media Report

Scene Investigation

Check all that apply

SIU Investigations

Auto Accident/Loss
Property Accident/Loss
Witness Canvass
Security Video Canvass
Obtain Statement(s) from any witnesses identified

Medical Canvasses

Please Check Services Requested

Medical Canvasses

Hospital
Pharmacy
MRI
Urgent Care
Primary Care
Orthopedic
Physical Therapy
Neuro
Cardiology
Chiropractic
Psychiatrist

Lifestyle Canvasses

Please Check Services Requested

Lifestyle Canvasses

Country Club
Gym/Training Facilities
Sports Leagues

Additional Case Notes

Subject Information

NOTE: If requesting multiple subjects, please contact our office.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Date of Birth

Is subject working?

Yes
No
Unknown

Please provide work location or schedule

Injury

Restrictions

Additional Subject Information

Is Subject Represented?

Yes
No
Unknown

Law Firm *

Attorney *

First

Last

Physical Description

Race

Hair

Sex

Build

Height

Weight

Other features you would like to highlight

Upload any files that will assist with your description

Click or drag files to this area to upload. You can upload up to 5 files.

Attach File (Database Reports, Photos, Other Documents)

Allen Investigative Group, LLC provides a wide range of confidential investigative services to law firms, insurance carriers, third-party administrators (TPA), corporations, and businesses of any size.

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Contact Us:

833-504-7214

[email protected]

PO BOX 1090

Skippack, PA 19474

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