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Request for Service

Privileged and Confidential

Requests for service are received by a secure server and are subject to stringent confidentiality guidelines set out by Quinn Investigations, the Council of Private Investigations of Ontario, and the Ministry of Community Safety and Correctional Services. Please note that submission of a request does not guarantee acceptance; all requests are subject to review and approval.

Please complete this form to initiate an investigation. A representative from Quinn Investigations will then be in contact with you. Information marked with an asterisk (*) is required.

Client Contact Information

Name*
Company
Telephone*
Fax
E-mail*
Budget
Claim/Reference No.
Policy No.
Date of Loss
Insured

Subject Information

Subject Name
Address
City

Postal Code

Drivers License
Sex MaleFemale

Phone Number(s)

Birth Date

S.I.N.

Marital Status

Spousal Information

Number of Dependents

Dependent Information

Height

Weight

Hair

Glasses


Nature of Injury
Employer
Occupation
Employer Address
Employer Phone
Lawyer

Physician

Appointments

Vehicle Information  Plate 
Additional Vehicle  Plate 
Additional Vehicle  Plate 

Please choose your preferred method of confirmation.


Type of Request

Investigative Request

Other Comments