You are on page 1of 2

Chris Loomis Consultations

-A Private Investigations FirmCA PI #24384


P.O. Box 660351
Arcadia, CA 91006
(626) 230-3137 Office (626) 407-4495 Fax
E-Mail: Chris@clcpi.com
SERVICE REQUEST FORM
Date of Request: ___

______

CLC Case No.:

__________________________

Client Needs Information By:

____

Next Court Date: __________________________

Client Name: ___________________________________________________________________________


Client Address and Contact Info.: ___________________________________________________________
_______________________________________________________________________________________
TYPE OF INVESTIGATION REQUESTED:

(Check All That Apply Please)

AOE/COE INVESTIGATION

SUBROGATION

SUBROSA / SURVEILLANCE

D.M.V. RECORD SEARCH

____ SPECIAL INVEST.

BACKGROUND INVEST.

____ SUBPOENA SERVICE

ACTIVITY CHECK

_____

CIVIL/CRIMINAL COURT CASE


___

FULL ASST. CHECK

LOCATE WITNESS & SECURE STATEMENT

MISSING PERSON/SKIP TRACE

_____

CRIMINAL DEFENSE CASE

SUBJECT:

____________

D.O.B:

Street Address:

____________________

Phone #: _____________

City:

________

Zip Code:

State: __

_______
_____

Social Security Number: ______________________ Drivers License # : _________________________


Physical Description:

Hair: __________ Eyes: __________ Height: _________ Weight: _________


Dominant Hand: __________ Glasses or Contacts: __________________________
Other Identifying Scars/Marks/Tattoos: ____________________________________
Language(s) Spoken/Accents: ____________________________________________

Vehicle Description:

Make:

____

CA. License Plate#:

Model: _____________
_____________

Other Identifying Marks/After-Market Parts: ________________________________


Service Req. Form v.01-2011

Chris Loomis Consultations & Chris Loomis PI 2011

Occupation/Employer: ____________________________________________________________________
How many days of Surveillance are you requesting? _____ Days
ADDITIONAL SUBJECT INFORMATION: _________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Pictures Attached:

YES

NO

(Circle One Please)

Court and Case Info.: _____________________________________________________________________


_______________________________________________________________________________________
_______________________________________________________________________________________
Clients Attorney Information.: ______________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Misc. Information.: ______________________________________________________________________


_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

THANK YOU FOR ALLOWING US TO SERVE YOU!

THE BEST COMPLIMENT WE CAN RECEIVE IS REFERRAL BY


YOU OF ANOTHER POTENTIAL CLIENT!
Service Req. Form v.01-2011

Chris Loomis Consultations & Chris Loomis PI 2011