Background Check Request Form

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 *
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

Background Check $ 12.00

Total $ 0.00