on the inside"

Insurance Client: Please fill out the necessary information on the claimant that you wish to be placed under surveillance.  All information is kept confidential and it will be reviews by our investigators at once. We thank you for your continued business and our best efforts will be put forward in this case matter.

Insurance Company:

Insurance Adjusters Name:

Your File Case #:

Claimant's Name: (please include middle Initial)

Claimant's Address: City:

State: Zip: Phone#: 

Claimant's Physical Looks, activities Lifestyle, Additional Information:


Services needed: Surveillance:     Activity Check    Special

Number of Days of Surveillance: 1 Day  2 Days 3 Days 4 Days5 Days

Comments or Directives for Surveillance

Please call our office and speaking with John Frycek for special directly
 and surveillance: (847) 803-6922




1508 Miner Street
Des Plaines, Illinois 60016
(847) 803-6922 Fax: (847) 803-9022
www.specialsol.com E-mail:  info@specialsol.com


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