Thanks for choosing Buffalo Protection
and Investigation, Inc. . There are 7 parts to the simple form below.
Please fill in as many or as few items as you wish. Just a quick message? Click Here.
|
Part #1 - Your
Details
(Unless you're a
returning customer, please supply your full contact information.
If you are a returning customer, simply fill in your
name.) |
Name (required) |
|
Company |
(if
applicable) |
Address |
|
Address 2 |
|
City |
|
State |
|
Zip |
|
Country |
(if non-US) |
Phone (required) |
(include area code) |
Extension |
(if
applicable) |
E-mail address (required) |
|
Best time to contact |
AM
PM
Any |
Preferred
method |
Phone
E-mail
Mail
|
Part
#2 - Attorney Details (if any) |
Attorney to receive a
copy?
Yes
No
If no, please skip to Part
3. If a report is to be addressed and mailed to an attorney,
please include attorney name and address here. |
Attorney name
|
(if other than referring party) |
Law firm |
(if applicable) |
Address |
|
Address 2 |
|
City |
|
State |
|
Zip |
|
Country |
(if non-US) |
Telephone |
(include area code) |
Extension |
(if
applicable) |
E-mail address |
|
Part #3 -
Investigation Type
Please choose
one that best describes your request. |
|
or other:
|
Special instructions |
|
Part #4 - Case
Details for Insurance Investigation
If you're not
submitting an insurance investigation, please skip this
part. |
Date of loss |
|
Claim # |
|
Occupation |
|
Employer |
|
Employer Contact |
(if necessary) |
Address |
|
Address 2 |
|
City |
|
State |
|
Zip |
|
Employer telephone |
(include
area code) |
Alleged injury |
|
Restrictions |
|
Complaints |
|
Special
instructions |
|
Part #5 - Subject
Details
Please provide as much information as possible
about the subject of your investigation. |
Name |
|
Gender |
Male
Female |
Address 1 |
(last known) |
Address 2 |
|
City |
|
State |
|
Zip |
|
Country |
(if
non-US) |
Telephone |
(include area code) |
Occupation |
|
Date of birth |
or Approximate age
|
Part #6 -
Identifying Features |
Height |
feet
inches |
Weight |
lbs.
Build
|
Hair color |
Length/Style
|
Facial hair |
|
Eye color |
|
Glasses |
|
Race |
Caucasian / African-American / Hispanic /
Middle-Eastern, etc. |
Distinguishing Marks |
scars/tattoos, etc. |
Vehicle
1 |
(color, make, model, plate
number) |
Vehicle
2 |
(color, make, model, plate
number) |
Vehicle
3 |
(color, make, model, plate
number) |
Any other details |
|
Part #7 Other
Requests |
| |
Please send literature
Use utmost discretion
when contacting me
|
| |
|
