America’s Private Investigation Network, Inc.

Headquarters:  1728 Main Street, Columbia, South Carolina  29201

 CLIENT INFORMATION

(PLEASE PRINT)

          Client Name______________________________________________________

          Street Address____________________________________________________

          City/State/Zip Code________________________________________________

          Date of Birth______________   Social Security Number___________________

          Drivers License Number/State________________________________________

          Phone Number____________________(Home)  ____________________(Office)

                   ______________________(Cell)    _____________________(Pager)

          Which of these phone numbers is OK to call?  ____________________________

          Best time to call____________________________________________________

          _________________________________________________________________

          Type Case:  ____Civil     _____Criminal     _____Surveillance     _____Domestic

                _____Attempt to Locate     _____Tracking Device

           Method of Payment____________________________________________