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Clear Capture Case Submittal Form

Please complete the following fields and press SUBMIT to assign a case to your Gainesville, FL Private Investigator, Clear Capture Investigations, Inc. A CCI representative will contact you to confirm receipt of the assignment and discuss the objectives of your request.

*Required Fields

Client Information

*Client Last Name
 *Client First Name
   
*Client Phone Number
 Client Other Contact
   
Client Company Name
 *Client Email Address
   
*Client Address
Subject Information

Subject Last Name
 Subject First Name
 M.I.
   
Select One:
Male    Female 		Date of Birth
   
SSN
  
   
Last Known Address
 Other Address
   
Vehicles and/or Physical Description
Claim Number
 Date of Loss/Injury
   
Type of Claim
Workers Compensation    Liability    Other
   
Sustained Injury
   
Requested Service:
Surveillance: Number of days
Activity Check
Background Investigation
K-9 Investigation
Accident Scene Investigation
Hospital/Pharmacy Canvass
Pre-Employment Screening
Other
   
Please list any additional information that may benefit this investigation including medical appointments, physical restrictions, specific dates for investigation, known activities, etc. Further, please give a detailed description of how you would like this investigation to proceed.

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