Employee Screening Secure Order Form

Cancellations are not permitted once your search has been initiated.

Name on Account/Registration:* USER ID:* Email Address or FAX # (for results):*

First Last
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Only one delivery method permitted per order form
First Employee
Employee's Name:* Employee's SSN:* Employee's DOB:  

First Last
No dashes or spaces
Employee's Address:*

Street Address
City
State
Zip Code
Select Services for this Employee:*
SSN $17.95
Verify an employee's Social Security Number 		DMV $34.95
Driver license search.

Driver License State


Driver License # 		Criminal $26.95
A statewide search.

State 		Sex Offender $11.95
A nationwide search of all 50 states including DC. This search is included in the comprehensive criminal. 		Comprehensive Criminal $69.95
A nationwide search of all states except DE, MA, SD & WY. Includes a nationwide sex offender search plus the FBI, ATF, DEA, US Secret Service and US Customs.
Second Employee (if applicable)
Employee's Name:* Employee's SSN:* Employee's DOB:  

First Last
No dashes or spaces 		 
Employee's Address:*

Street Address
City
State
Zip Code
Select Services for this Employee:*
SSN $17.95
Verify an employee's Social Security Number 		DMV $34.95
Driver license search.

Driver License State


Driver License # 		Criminal $26.95
A statewide search.

State 		Sex Offender $11.95
A nationwide search of all 50 states including DC. This search is included in the comprehensive criminal. 		Comprehensive Criminal $69.95
A nationwide search of all states except DE, MA, SD & WY. Includes a nationwide sex offender search plus the FBI, ATF, DEA, US Secret Service and US Customs.

Payment Information (VISA or MasterCard only)
Visa or MasterCard Acct #:* Exp. Date:* CVV #:*

16 digits begining with the number 4 or 5 		No dash, slash or space 3 digits on back of card
Billing Address:*

Address where you receive this card's statement 		City State
Zip Code