Email: admin1@expedientinfo.com
Phone: (714) 851-2779
Fax: (714) 908-8533
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Requester: This area is for information about you, the requester of the investigation.
Name: Company:
Email: Phone:
Claim Number: Address:
Date of Loss: Zip Code:
Defense Attorney: Attorney's Phone:
Send Report to Attorney? Decision Date:
Claimant: This area is for information about the person whom you are requesting an investigation of.
Name: Phone:
Date of Birth: Address:
Social Security Number: Zip Code:
Type of Injury:


Physical Desciption:
Vehicles:
Claimant Attorney's Name:
Insured:
Name: Employer Contact:
Address: Phone:
Zip Code: