Account Request Form
Company Information
Company Name
Street Address 1
Street Address 2
City
State
Zip/Postal Code
Country
Invoicing Information
Billing/Physical Address Same?
Yes
Invoice Email Address
Street Address 1
Street Address 2
City
State
Zip/Postal Code
Country
Primary Contact Information
First Name
Last Name
Title
Office Phone
Mobile Phone
Fax
Email
Additional Questions
How did you hear about us?
Referred by Deep Screening Client
Received Direct e-Mail from us
Received Postcard from us
Google or other Search Engine
Social Media
If Referred, list by whom
Approximately How many backgrounds do you expect per year?
Under 50
51-100
101-500
501-1000
1000+
If you have a Promo Code, enter here
What is your primary industry or business type?
Background Check Questions
Please list specifics for the type of background you need to perform for your first background and/or drug test
Statewide Criminal
County-Level Criminal
Federal Criminal
National Criminal (Stored DB)
Sex-Offender Search
Global Watch Lists
County Civil
Employment Verifications
Education Verifications
Reference Verifications
License/Certification Verifications
10-Panel Drug Screen
Driving Records
List any other requirements below
If you are complying with another company's requirements, you may list those here