Date
Your Name
Your Company
Your Mailing Address
Your Street Address (if different)
City
State
Zip
Your Phone Number Work
Cell
Fax
Email Address
Your File Number
(if
previous customer)
Date Of Assignment
Budget Assigned
Want us to call you prior to starting?
-- Please select --
Yes
No
Your Case Number
Police Agency
Police Case Number
Date of Accident
Location of Accident
Name of Insured Driver
Please select what you want Carters Investigations to do
Purchase a copy of the police report
-- Please select --
Yes
No
Interview your driver
-- Please select --
Yes
No
Interview passengers in the insured
vehicle
-- Please select --
Yes
No
Secure copies of police interviews
-- Please select --
Yes
No
Are any involved represented now?
-- Please select --
Yes
No
Is this a homicide or serious injury
report
-- Please select --
Yes
No
Purchase officer's field notes?
-- Please select --
Yes
No
Purchase officer's photos?
-- Please select --
Yes
No
Take photos of scene as
it appears today?
-- Please select --
Yes
No
Take photos of vehicles
involved?
-- Please select --
Yes
No
Which Vehicles are to
be photographed?
Purchase journalist
articles and photo media?
-- Please select --
Yes
No
Canvass immediate
neighborhood for new witnesses
-- Please select --
Yes
No
Interview wrecker
operator who responded to the accident?
-- Please select --
Yes
No
Measure scene and skid
marks with sample of roadway?
-- Please select --
Yes
No
Purchase E.M.T. run
reports where available?
-- Please select --
Yes
No
Interview E.M.T.
personnel who responded?
-- Please select --
Yes
No
Pull master public
record with crash history and assets
-- Please select --
Yes
No
Pull 12 year MVR on all
drivers?
-- Please select --
Yes
No
Additional information and instructions: