Order by Mail

Please print and complete this form to order services.

Potential Employee Information:

Please fill out the RELEASE FORM.
Print Name:___________________________ Soc. Sec. #: _________-_______-_______
Date of Birth:__________________________ Sex __Male  __Female
Race:  __White  __Black  __Hispanic  __Asian  

Requester Information

Print Name:___________________________ Please   Fax   Mail  my report (circle choice).
Current Address:_______________________  
City:________________________________ State:______ Zip:___________-_______
Phone Number:(____) ______-____________ Fax Number:(____) ______-____________
Visa:____  MasterCard:____ 
Card Number:_________________________ Expiration Date:_____/_____/_____
Name as it appears on Card:___________________________________________

Please Select Report Types:

____ Social Security Number Verification  
Not all states offer all reports, please see Pricing Information for a complete list.
____ Criminal History (County) ____ Criminal History (Statewide)
List Counties: _______________________________ List States:_________________________________
____ Motor Vehicle History  
List States:_________________________________  
____ National Wants And Warrants ____ National Sex Offender
____ Criminal History (County) ____ Criminal History (Statewide)

P.O. Box 1504
Dawsonville, GA 30534
770-205-1828 (phone)
770-205-8036 (fax)