Name: 

Company Name: 

Telephone number:  Fax number: 

Application type: Individual     Partnership     Corporation

States of Operation:   

Do you carry a firearm? Yes     No

Annual payroll for investigator employees (W-2'd)         

Annual payroll for sub-contracted investigators (1099'd): 

Check categories of investigations performed:
     Credit or Pre-Employment
     Insurance/Legal
     Domestic/undercover
     Auto Repossessions
     Executive protection
     Shopping service
     Fire investigations (causes and origins)
     Other

Current insuring company: 

Current type of policy form: Occurance     Claims made

Have you had any claims in the last three years?  Yes     No