Fingerprint Client Intake Form

Fingerprint Client Intake Form

Please provide your information to schedule and complete your fingerprinting service. Complete as much information as possible to avoid any delays during your appointment. If you have any questions do not hesitate to call us (305)464-0645.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Residential Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Occupation
What Country were you born in?
What Country are you a Citizen In?
Gender
Race
Height
Weight
Eye Color
Hair Color
Date of Birth
Social Security Number
Select the service you need:
ORI Number (Required):(Example: FL920010Z)
Agency/Employer Requiring Fingerprinting:
Agency/ Employer Requiring FingerPrints Address
Reason for Background Screening:

Other
If other, please specify
How many fingerprint cards do you need?
Upload a clear Photo ID (Driver License, State ID or Passport)

Cancelof
Preferred Appointment Date and Time
Payment is required to secure your appointment. All payments are non-refundable within 24 hours of the scheduled appointment.

FD-258 Ink and Roll Cards

Ink and Roll fingerprint card

$50.00 Quantity
Item subtotal:

Livescan Finger Print

FDLE Livescan

$125.00 Quantity
Item subtotal:

Total

Signature
By submitting this form, I confirm that all information provided is accurate, that I will bring a valid ID to my appointment, and that I understand service fees are non-refundable once fingerprinting services begin. I understand that it is my responsibility to provide the correct ORI number, card type, and agency information if required by the requesting organization.
Should be Empty: