EBS Investigations Apopka, Orlando, Florida
 
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Requestor Name:
Company:
Address:
City:
State:
Zip Code:
Phone Number:
Fax:
E-Mail Address:
Insured or Client name:
Your File #:
Claim #:
Date of Loss:
Case #:
Style of Case:
Type of investigation:
If Special Investigation, please provide specific request:
If Surveillance, please specify total hours/days authorized:
Subject Name:
Subject Address:
Type of injury
Subject is represented by: 
Self Attorney
If subject is individual, please provide the following information
DOB or approximate age:
Florida Drivers License #:
If related to vehicle crash, please provide the following:
Vehicle Year/Make/Model (ex: 1998 Ford Taurus):
Subject was:
VIN #: (If accident report is illegible, please provide as many digits as possible)
Tag #: (If accident report is illegible, please provide as many digits as possible)
Additional Instructions:
 

EBS Investigations Apopka, Orlando, Florida © copyright 2009-2011 all rights reserved  |  Web Development by Webskinz
 
Insured and Licensed in the State of Florida, Agency #A2100311
Member: Florida Association of Licensed Investigators
Member: National Association of Legal Investigators
Member: Apopka Area Chamber of Commerce
Affiliate Member: Orange County Bar Association