General Case Intake Form - Private Investigator, Private Detective, CT, MA, RI, NY, NYC

DIOGENES LLC - Case Intake Form

Please note: Submitting this form does not constitute a contract or agreement that Diogenes LLC will perform any services on your behalf. Once we receive your information, we will review your case and an agent will contact you by the method you have chosen above to discuss your options. All information supplied is kept strictly confidential. A case is considered accepted when an INVESTIGATIVE SERVICES AGREEMENT has been fully executed and submitted to Diogenes LLC. If the client elects not to, or fails to, complete and submit the INVESTIGATIVE SERVICES AGREEMENT, the client acknowledges and approves that the standard (default) published provisions of the agreement will apply. Only the final written quoted rates and costs fields may be modified for the purposes of the standard (default) published INVESTIGATIVE SERVICES AGREEMENT.

Certification and Affidavit:
By submitting this online form, I hereby certify and affirm that the information supplied above is true and accurate to the best of my knowledge at this time. I further represent and affirm that I am authorized to order and financially contract for this assignment and am not prohibited by any court order to conduct said investigation. I understand that my knowingly supplying false or misleading information may result in my case being rejected. I will forfeit any and all funds that may be paid to the Agency pertaining to this case if any information is discovered to be false, misleading, or compromising the ethical and/or legal obligations of the agency .

I have read and agree to the conditions stated above *

Your Details: Please supply your full contact information. Note: fields marked with an * are required and must be completed.
First Name:	*
Last Name:	*
Company:	(If Applicable)
Address:	*
Address 2:
City:	*
State:	*
Zip Code:
Country:	(if non US)
Telephone:	* (203-555-1212)
Extension:	(If Applicable)
Fax:	(203-555-1212)
E-mail Address:	*
Social Security #
Date of Birth:
State Drivers License #
Best time to contact:	AM: PM: ANY:
Preferred Method:	Phone Email Mail
Investigation Type Please choose one which best describes your request. Check the box to the "right" of the service desired.
	Asset Search Surveillance Background Check Computer Forensics Criminal Defense Cyber / Internet / E-mail Electronic Surveillance Detection / TSCM Fraud / Theft Interview / Statement Litigation Support Locate/Skip Trace Missing Persons Non-public Information Services (Telephone #s, Tolls, Utilities, etc.) Polygraph Pre-employment Screening Undercover
Other:	(Please specify)
Reason for Request Please outline the reason you require this investigation.
	*
Relationship to Subject:	* (Family, Friend, Creditor, Employer, etc.)
Subject Details Please provide as much information as possible about the subject or your investigation.
Your Case/File #
Full (Proper) Name:	(Example: John Q. Public)
or Company Name:
(Last Known) Address:
Address2:
City:
State:
Zip:
Country:	(if non US)

Telephone:	(203-555-1212)
E-mail Address:	(johndoe@aol.com)
Social Security #	Male: Female:
Date of Birth:	or Approximate Age:
Marital Status:	(Single, Married, Divorced, Separated or Widowed)
Automobile Make:	(Ford, Mercedes-Benz, Pontiac, GM etc. )
Automobile Model:	(2 door, 4 door, SUV, Pickup, Truck etc.)
Automobile Color:
Automobile Registration / Tag #	(Example: 333-CAR Note: "-" is used to indicate where there is a separation between numbers or letters.)
State of Registration:
Identifying Features
Height:	feet inches
Weight:	lbs.
Hair Color:	Length/Style:
Eye Color:
Race:	(White, Black, Hispanic, Asian e.g.: Chinese), etc.
Distinguishing Marks:	(Scars, Tattoos, Piercings etc.)
	Please include below ANY further information you know about the subject, such as the High school or college attended, type of work they do (or did), city or state of birth, what city or state you believe or know they live in now, professional memberships i.e. unions, accountant, dentist, likes and dislikes, hobbies, etc. EVERY detail you can give may help us solve your case more quickly.
Other Details:
Other Request:
	Please send literature Use discretion when contacting me
Please note: Submitting this form does not constitute a contract or agreement that Diogenes LLC will perform any services on your behalf. Once we receive your information, we will review your case and an agent will contact you by the method you have chosen above to discuss your options. All information supplied is kept strictly confidential. A case is considered accepted when an INVESTIGATIVE SERVICES AGREEMENT has been fully executed and submitted to Diogenes LLC. If the client elects not to, or fails to, complete and submit the INVESTIGATIVE SERVICES AGREEMENT, the client acknowledges and approves that the standard (default) published provisions of the agreement will apply. Only the final written quoted rates and costs fields may be modified for the purposes of the standard (default) published INVESTIGATIVE SERVICES AGREEMENT. Certification and Affidavit: By submitting this online form, I hereby certify and affirm that the information supplied above is true and accurate to the best of my knowledge at this time. I further represent and affirm that I am authorized to order and financially contract for this assignment and am not prohibited by any court order to conduct said investigation. I understand that my knowingly supplying false or misleading information may result in my case being rejected. I will forfeit any and all funds that may be paid to the Agency pertaining to this case if any information is discovered to be false, misleading, or compromising the ethical and/or legal obligations of the agency . I have read and agree to the conditions stated above *