Membership Application

It is required prior to placing an order for services that you complete the following Membership Application

*All Fields are Required 
 Your information WILL NOT be distributed to any Third Parties, and is only required for order tracking and billing purposes.
 
Your Name:


 Company Name: (if applicable)


Address:



 Phone:


 Email Address:
(your email address is required as this is where the results of your request will be sent)       



Fax::

Username: Must be unique and begin with a letter. (e.g. Bob123)

Password: Must be at least 9 characters in length 
(e.g. tauby1937)

Verify Password:

Disclosure Statement 

My normal course of business for which I will be requesting services are for the following reason(s): 

A

 I am conducting work in conjunction with official government business.

B

 I am conducting work in connection with identity fraud.

C

 I am conducting work involving a fraud investigation

D

 I am conducting work in a civil or criminal investigation..

E

 For a legal purpose to which I am legally entitled under FCRA.

F

 Uniting separated families, locate a lost / missing friend or relative.

G

 Child support enforcement / debt collection.

H

 Employment Investigation / pre-employment screening.

I

 Locate individual(s) in relation to legal proceedings.


I have read and agree to the Public Record Checks Consumer Services User Agreement.


I understand I must fill out and return via fax the Subscriber "Terms of Agreement form prior to placing a request. Please Fax to: 972-692-7626

I understand that payment for services must be received prior to the release of findings.


I understand that payment for services are only accepted via Credit Card or E-Check through  Merchant- PAYPAL Secure, an online non-affiliated Payment Processing Center. 
* Additional payment plans MAY be available upon special request.


I understand and agree that if paying by credit card my credit card statement will show a billing as  T.I.A. /Paypal.

Electronic Signature (Type in your full name):

 
Date:



After hitting the SEND button you will be directed to a confirmation page, if you do not choose the "click to continue button" your order will not be received.