Palmetto Compliance & Testing | Group Fingerprinting Service Request
Please complete this form to request group fingerprinting services for your business, organization, agency, or group. Palmetto Compliance & Testing will review your request and contact you regarding availability, scheduling, and applicable service fees.
Contact Information
Contact Name
*
First Name
Last Name
Business | Organization Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Please Select
Phone
Email
Text
Group Fingerprinting Details
Number of Individuals Needing Fingerprinting
*
Purpose of Fingerprinting
*
Please Select
Employment
Licensing or Certification
Education
Healthcare
Legal or Agency Requirement
Volunteer
Other
Type of Fingerprint Card Needed
*
FD-258
Agency-Provided Card
Not Sure
Other
Has the requesting agency provided fingerprinting instructions?
*
Yes
No
Not Sure
Service Location
Where would you like fingerprinting completed?
*
Please Select
PCT Office
Mobile at Our Location
Not Sure
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Location
*
Please Select
Business
Office
School
Facility
Event
Other
Scheduling
Preferred Service Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Time Range
Please Select
8:00am-10:00am
10:00am-12:00pm
12:00pm-2:00pm
2:00pm-4:00pm
4:00pm-6:00pm
6:00pm-7:20pm
Is your requested date flexible?
Yes
No
Is there a deadline by which fingerprinting must be completed?
*
Yes
No
Deadline Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Information
Special Instructions or Additional Details
How did you hear about us?
Please Select
Google Search
Google Maps/Google Business Profile
Facebook
Referral from a Friend or Family Member
Referral from an Employer / Organization
Healthcare Provider / Facility
School / Education Institution
Attorney / Legal Professional
Government Agency
Community Event / Networking Event
Business Card / Flyer / Brochure
Returning Client
Other
Please tell us how you heard about us:
Request Acknowlegment
Group Fingerprinting Acknowledgement
*
I understand that submitting this form is a request for group fingerprinting services and does not confirm an appointment, availability, or final pricing. Palmetto Compliance & Testing will contact me to review the request and coordinate service arrangements.
Mobile-Service Acknowledgment
Acknowledgment
*
I understand that mobile fingerprinting services are subject to availability and that additional travel or mobile service fees may apply based on the service location and request.
Communication preferences
Palmetto compliance & Testing may need to contact you to discuss scheduling, service requirements, pricing, or additional information related to your request.
*
I authorize Palmetto Compliance & Testing to contact me regarding this group fingerprinting service request using the contact information provided above.
Date Signed
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Group Fingerprinting Request
Should be Empty: