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*Your Vehicle Information*
*Your Contact Information*
  Vehicle 1 Vehicle 2 (if applicable)
Make
*
Model
*
Color
*
Plate#
Drivers License #*
Year
Home Address*
   
Phone*
*Subject's Vehicle Information*
      Vehicle 1 Vehicle 2 (if applicable)
Contact Time
Make
Preferred Method
Model
       
*Subjects Contact Information*
Color
Relationship to Subject
Plate#
Year
     
Address
*Subjects Information Continued*
City
Date of Birth
Height
State
License #
Weight
Zip
SS#
Hair Color
Phone
Sex
Race
Marital Status
Other Details (tattoos, scars, etc)
   
   
Workers Compensation Cases
Description of Claimants Disabilities/Restrictions
State of Loss
Date of Loss
Occupation
CurrentlyEmployeed
     
 
Additional Comments or Details - Please include any further information you know about the subject, such as the High School/college they attended, type of work, city or state of birth, where they may live now, professional memberships, i.e. unions, accountant, dentist, locations, subject frequents. EVERY detail you can give may help us expedite your investigation.
Additionally, please list all details that you have on your case. For example: In a domestic case you would list why you think your significant other is cheating. When/Where they are cheating, etc. In a theft case you would list what was stolen, where is/was stolen from and who you think took it and why.
Terms and Conditions - Submitting this form does not constitute a contract or agreement that Bynum Private Investigations will perform any services on your behalf. Once we receive your information,we will review your case and will contact you by the method you have chosen above to discuss your options. All information is kept strictly confidential. 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 understand that my knowingly supplying false or misleading information may result in my case being rejected and will forfeit any and all funds that may be paid to the agency pertaining to this case I also understand that any decision regarding refunds is left solely to the discretion of Bynum Private Investigations and not directly for a particular result.
 
I HAVE READ AND AGREE TO THE CONDITIONS STATED ABOVE

BYNUM PRIVATE INVESTIGATIONS - ALL RIGHTS RESERVED - COPYRIGHT 2009 PI Lic #26722
Randy Bynum PI (831) 809-7117