Background Check Request Form
Please allow 3-5 business days to receive your background report by U.S. Mail.
Date of Request
*
-
Month
-
Day
Year
Date
Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Other Legal Names Used (i.e.: MAIDEN)
First Name
Middle Name
Last Name
Suffix
Race
*
American Indian
Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Sex
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Last Four Digits of Social Security Number
Name of Person to Receive Background Report
*
First Name
Last Name
Address to Mail Background Report
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Payment
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Background Check
$20.00
$
20.00
Total
$0.00
$
0.00
Credit Card
Submit
Should be Empty: