Subject Information
Full Name:
AKA / Maiden Name:
Date of Birth:
SSN:
Race:
Please Choose White Black Hispanic Asian Native Unknown
Gender:
Please Choose Male Female Unknown
Driving License #
Name of Spouse:
Last Known Address:
As of date:
Employer:
As of date:
Home Phone:
Work Phone:
Additional Info:
Purpose of Request (MUST have a Permissible Purpose) PLEASE FAX SUPPORTING DOCUMENTATION.
(Check all that apply)
Child Support Enforcement
Judgment Enforcement
Documented Civil/Criminal Action
Collections
Other Permissible Purpose **
** Please Explain
Investigation Type
Asset and Skip-Tracing Searches:
Skiptrace/Subject Locate
Nationwide Super Snooper
Employment Locate
Financial Assets Research (must fax copy of judgment prior to ordering)
Social Security Number Locate
Motor Vehicle Ownership
Real Property Ownership
Civil and Criminal Searches
Statewide Criminal Records Check
Multi-State Criminal Database Check
On-Site Criminal Record Search
On-Site Civil Record Search
Note: Complete State or County to search in Special Instructions section (at bottom)
Hourly Services
Surveillance
Internet Investigations / E-Mail Tracing
Phone Searches
Phone Trace (gives name/address)
Client Information (Fields marked * are required)
First Name:
*
Last Name:
*
Company:
*
Phone:
*
Fax:
*
E-Mail:
*
Preferred Method of Report Delivery?
Please Choose Fax (please include fax number above) E-Mail (please include e-mail address above)
Client Case/File Reference Number:
Special Instructions:
I affirm that the above statements are true and correct and that all requests for the information are made for the common good of the consumer and the potential benefits far outweigh any potentially injurious effects. Furthermore, I agree to hold Ekeholm and Associates, LLC, and its principals, harmless for all requests made for information and that such requests have a permissible purpose pursuant to the Fair Credit Reporting Act (15 U.S.C. 1681b) Section 604. Verification and appropriate documentation will be required prior to commencement of any search requiring a permissible purpose. This Order Form is for current clients ONLY . Please contact Ekeholm and Associates, LLC prior to utilizing this Order Form. Prices are subject to change without notice.Disclaimer: All non-public information searches require a permissible purpose, which is outlined on the Order Form, Contract, and appropriate documentation will be required. Fees are subject to change without notice. All of our services are investigative, by nature, and subject to human error and/or data entry and therefore we make no warranties or guarantees as to the accuracy of the information we retrieve nor promises that the end or desired results will be obtained under any circumstance. We do guarantee that we will use our due-diligence in obtaining and reporting the most current and accurate information available, while complying with all federal and state laws, and how our fees are based. Therefore, All services should be utilized for lead or information purposes only.
