Submit a New Assignment

Please fill out the assignment form to the best of your ability and we'll get to work, making the investigation experience effortless and effective. If you'd prefer to contact us directly via email or phone, please feel free to drop us a line at info@fairleadgroup.com or 862-339-4318. Most of the fields that follow are optional but please include as much information as possible for an efficient investigation.

Submitter Information - How can we reach you?

Name:

Member/Insured:

Phone:

Email:

Subject Information

Claim #:

Date of Loss:

Claim Type:

Vessel Name:

Allegation:

Member/Insured Information:

Phone:

Subject:

DOB:

SSN:

Gender:

Height/Weight:

Ethnicity:

Phone:

Address:

Requested Services

Please indicate all investigative services that apply to this assignment

Surveillance Services

Please detail the requirements for in-field surveillance

Surveillance

Number of Days:

Reason for Surveillance / Additional Details:

Attach Files:

Open-Source Services

Please detail the requirements for the open-source assignment request (i.e. background investigation, canvass activity, etc.)

Open-Source Investigations

Reason for Open-Source Investigation / Additional Details:

Attach Files:

SIU Services

If you believe you require SIU services on this assignment, a special investigator will be in contact with you directly within 24 business hours.

SIU Investigation

Reason for SIU Investigation / Additional Details:

Attach Files: