LEVEL 2 LIVESCAN SCHEDULING + PAYMENT FORM
This form is for Records Checks and Fingerprinting Services
Client Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
APPOINTMENT SCHEDULING
Appointment
*
TERMS & SIGNATURE
TERMS
*
I understand that all payments are non-refundable.
I understand that Tailored Services is not responsible for prior occurrences, errors, delays, or state agency processing times.
I certify the information provided is accurate.
Signature
*
Select Service Type(s):
*
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Agency for Healthcare Administration (AHCA)
$
95.00
Agency for Persons with Disabilities (APD)
$
88.00
Department of Children and Families (DCF)
$
85.00
Voc Rehab (Employee)
$
85.00
Voc Rehab (Volunteer)
$
75.00
Department of Education (DOE)
$
90.00
Department of Business and professional Regulations (DBPR)
$
95.00
FSU- LISA TRONE
$
75.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: