P.O. Box 1269 Lawrenceville, Ga. 30046
Tel: 770-339-1551   |    Fax: 770-339-1551

Case Assignment Form

Please Fill Out This Form Completely. Fields with a * are mandatory

Your Details: First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip:
*
E-mail:
*
Telephone:
ie: 123-456-7890
Best time to contact:
AM PM
Preferred contact method:
 Phone E-mail Mail
   
Investigation Type:
Other:
(Please specify)
   
Subject Details :
  
Full Name:
Address:
City:
State:
Zip:
Telephone:
ie: 123-456-7890
Date of Birth:
Social Security #:
   
   
         Other Details:

Submitting this form does not constitute a contract or agreement that Perry Investigations, Inc. will perform any services on your behalf. Once we receive your information, we will review your case and an agent will contact you by the method you have chosen above to discuss your options. All information supplied is kept strictly confidential.

Certification and Affidavit:
By submitting this online form, I hereby certify and affirm that the information supplied above is true and accurate to the best of my knowledge at this time. I understand that my knowingly supplying false or misleading information may result in my case being rejected and I will forfeit any and all funds that may be paid to the Agency pertaining to this case.

I have read and agree to the conditions stated above *

 
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