Basic Background Check
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        I would like to order a Basic Background Check for $39.00, plus $ 2.00 shipping and
        handling, for a $41.00 total.

        Your Name: |__________________________________________|

        Your Address: |_______________________________________|

        City: |______________________|  State: |___|  Zip: |________|

        Your E-Mail address: |___________________________|

        Your Day Telephone Number: |_(____)____________|

        Your Evening Telephone Number: |_(____)____________|

        Your Fax Number: |_(____)____________|

         ***I would also like to add:
               A Misdemeanor Criminal Record Check  _____
               A Felony Criminal Record Check  _____
               A Civil Record Check _____
               Select county and or counties to run the Criminal/Civil Check__________________
               Please add $45.00* for each Check /Per County requested.
               If unknown WhoisHe.Com/WhoisShe.Com will send a list of Counties
               that is recommended by the address(es) that the party has lived at.***
              *( Note: Criminal or Civil Background Checks may very in price from $45 to $65
                  depending on the County Requested)

        Their Name: |______________________________|  Male or Female: |_________|


        Their Address: |___________________________|


        Their City: |______________________________|


        Their State: |__________|       Their Zip: |_______|


        Their Telephone Numbers:


                Home:  |_(____)____________|    Work: |_(____)____________|


                Pager: |_(___)_____________|    Cell: |_(____)____________|


        Their Age: |______|             Their DOB: |___/___/___|


        Their Occupation: |_________________________|


        Their Employer (if known): |________________________|
        What is the purpose for the Background Check: |___________________|
    
        Please let us have any other information you can supply here:


        |___________________________________________________________|


        |___________________________________________________________|


        |___________________________________________________________|


        |___________________________________________________________|


        |___________________________________________________________|


        |___________________________________________________________|


        |___________________________________________________________|




        Where did you see hear about us? |__________________|


        Is this the first time you have used our services |_Yes / No_|


        How do you wish to order? (Please check one)


                By Fax & Credit Card    |__|


                By Mail and Credit Card |__|


                By Mail and Check       |__|


        If Credit Card, the following information is required:


                Full Name of person on card: |_____________________|


                Credit Card Type: |____________________|


                Credit Card #: |____________________|


                Expiration Date: |________________|


                Amount Authorized:   |$___________|
                Credit Card Billing Address:  |___________________________|
                                              |___________________________|
                                              |___________________________|


                Signature: |______________________________|


 
      All search results will be both e-mailed and sent by regular U.S. mail.