*Required Information

Step 1 of 4: Company Information

Company Name:* Contact Name:*
Company Telephone:* Company Fax:*
Company Email:* Company Website:
Address Line 1:* Address Line 2:
City:* State:*
Step 2 of 4: Account Preferences
'Account Login' email address for your new business account?:*
How many searches do you anticipate to submit per month?:
Which fax number will receive the search results?:*
How did you hear of us?:
Step 3 of 4: Comments
Step 4 of 4: Authorized Signature
Upon initialing this form, I hereby attest that I am the authorized representative for the above named company and agree to the terms and conditions of opening a new business account.

We herby request Federal Background Services, Inc. to open an account for the above named company. We herby authorize your company to be our agent for background investigation searches for pre-employment purposes. The information received from your company will be held in strict confidence.

Authorized Initials:* Date:*




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