Private Partners, Inc. - Case Handler/adjuster case Referral assignment form, Florida, Dominican REPublic, Private Detective, Private INvestigator,

Private Investigator Florida, Dominican Republic

Private Partners Inc "A Private investigation Company"

Private Partners, Inc " Serving the State of Florida, Dominican Republic" Statewide investigation Services""A full service investigation company" Florida License #'s A2000291, C9400021, G2600955 Email: info@privatepartnersinc.com

Ph: 772-589-8233 Toll free: 1-888-277-4779 " Your Florida, Dominican Republic, Private Investigation Specialists"

Private Partners, Inc.

ph: 772-589-8233
alt: 1-888-277-4779
info@privatepartnersinc.com

Case Handler/adjuster case Referral assignment form, Florida, Dominican REPublic, Private Detective, Private INvestigator,

Assignment Form Instructions:

Please complete and submit the information below to request services or additional information or click here for a printable version.

INSTRUCTIONS: To navigate from one filed to the next, please press the "Tab" button on your keyboard or use your mouse to click the appropriate box. When finished completing the form, check the box at the bottom of the page and click the "Submit" button or press the "Enter" button on your keyboard to submit your request. Thank you! We appreciarte your business. Feel free to call us or send us any comments or suggestions in regards to any investigative matter.

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*Company or name of firm:

*Case Type:

*Case Handler/Adjuster First Name:

*Case Handler/Adjuster Last Name:

*Case Handler Email:

*Mobile Phone or office phone

Case or Claim Number:

*Case Type: Workers Comp, Bodily Injury, Liability

*Claimant First Name:

*Claimant Last Name:

*Claimant Social Security Number:

*Claimant Address:

*Claimant City :

State/Province:

ZIP/Postal Code:

Country:

*Case Due Date:

*Would you like to be updated by phone or email?

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Additional Comments:

Submit Your Case :

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Private Partners, Inc.

Office: Miami Florida

12262 SW 148th

Miami, Florida 33186

Private Partners, Inc.

Office: Dominican Republic

Ave San Jose #2, Janico, Santiago

Avenida San Jose De Las Matas

Republica Dominicana (Dominican Republic)

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