BACKGROUND & LIVESCAN FINGERPRINTING
This form is for Records Checks and Fingerprinting Services
Client Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
APPOINTMENT SCHEDULING
Appointment
*
TERMS & SIGNATURE
TERMS
*
I understand that all payments are non-refundable.
I understand that Tailored Services is not responsible for prior occurrences, errors, delays, or state agency processing times.
I certify the information provided is accurate.
Signature
*
My Products
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Agency for Healthcare Administration (AHCA)
$95.00
$
95.00
Department of Health (DOH)
$95.00
$
95.00
Agency for Persons with Disabilities (APD)
$88.00
$
88.00
Department of Children and Families (DCF)
$85.00
$
85.00
Voc Rehab (Employee)
$85.00
$
85.00
Voc Rehab (Volunteer)
$75.00
$
75.00
Department of Education (DOE)
$90.00
$
90.00
Department of Business and professional Regulations (DBPR)
$95.00
$
95.00
FSU- LISA TRONE
$75.00
$
75.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
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