Information about you (This is confidential)

Please enter your Name
Please enter your Company or Organization
Please enter your Mailing Address
Please enter your City, ST., Zip
Please enter your Phone Number
Enter best time to call you
Please enter your E-Mail address [Required]

Requestor/Client Information

Are you or do you represent?
Individual/Private Party
Attorney or Law Firm
Physician or Medical Facility
Insurance Company
Criminal Justice Agency
Coroner/Medical Examiner
Business or Corporation
Funeral Home or Director
Other (Not listed above)

Priority:

Is your request: Urgent?Routine?

Type of Request:

Is this request for: Information Only? Investigation?

Services/Information Requested

What services or information are you interested in? (Click to select) Forensic Autopsy Death Investigation Homicide Investigation Suicide Investigation Accidental Death Investigation Insurance Claim InvestigationMedical Background Investigation Wrongful Death Investigation Medical Misadventure InvestigationTrial Preparation or Legal Investigation Medical Examiner/Coroner Support Services Public Records and Database Research Forensic Investigation of Crime/Death Scene Obtain or Review Police, Fire or Coroner Reports Forensic Photography Training ServicesTraining SeminarsForeign Death AuthenticationWorkplace Accident InvestigationInvestigation not listed aboveCritical Incident ManagementEmergency Plan ConsultingGeneral Company InformationEmployment/Networking Opportunities 

Subject of Investigation

If you are requesting an investigation, enter following information regarding the Subject of your investigation. (Leave blank if not applicable.)

Enter Subject or Decedent Name
Enter Claim, Policy, or File Number
Enter Subject Mailing Address
Enter Subject City, ST, Zip
Enter Subject Phone Number
Enter Beneficiary or Next-of-Kin Name
Enter Date of Death for Subject
Enter Other ID for Subject (SSN, Medical Record Number, etc.)
Enter Circumstances of Death or Claim
Enter Type of Injury or Death
Enter Location of Death for Subject
Enter Date of Coverage/Application
Enter Date of Death for Subject
Enter Type of Coverage or Policy

Your Comments

Please provide a brief description and background of the investigation you are requesting or enter your comments.

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Emphasis Technography, Ltd
PO Box 158
Sumner, WA 98063-0030
253-833-4024
E-Mail: info@emphasis-technography.com
WA License #434 - CA License #PI18269

© 1997, 2002 Emphasis Technography, Ltd. All rights reserved.