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Note: I certify that I have a written authorization from the individual listed below and that I am in compliance with all applicable laws pertaining to a "consumer report" as defined in the Fair Credit Reporting Act as amended.
Company Name:

Address:  City: State: Zip

Requestor's Name:

Your Telephone Number:    Your Email Address:

Preferred Payment Method: You can also pay in various ways on Pay My Bill page.

Name on Card:  Card Number:Expiration Date:

Reports can be returned by email or fax. They can also be in several different formats, such as Microsoft Excel, or in .pdf (Adobe Acrobat). Please mark below how you would like to have your results returned.

Please return results by: Email-    Fax-

If returning by Email, would you like the attachment in:  Excel Format     .pdf (Adobe) Format

First Name: Middle Name:Last Name:

Other Names Used:*Note there is additional charges for each name searched

Social Security Number:  Verify? Yes No      Date of Birth:

Current Address City: State: Zip

Please Search the below locations on the above individual

County                                                       State             Criminal        Civil       Check:

                                   

                                   

                                   

                                   

                                   

                                   

Additional Comments:

Please Make sure everything is completed and correct before submitting.