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[FrontPage Save Results Component] Date of Request: Person Making Request: Address: Phone Number: FAX: Reason for Request (i.e. Employment, Tenant, Roommate, etc.): AREAS TO BE SEARCHED (Area 1) City County State (Area 2) City County State (Area 3) City County State (Area 4) City County State Total Number of Areas to Search: 1 2 3 4 SUBJECT INFORMATION Name: DOB Race Sex Height Weight   Hair Eyes S.S.# DL# State Issued Address Apt. City State Zip Home Phone Work Phone REMARKS This organization cannot guarantee the inquirer that this person has not committed a criminal offense(s) in the past -- some reasons why a past criminal record could not be found might be but not limited to: criminal activity committed prior to age 18; recent affidavit not yet filed; recent warrants not yet filed and/or served; person had records sealed and/or expunged; plea bargaining; inaccurate and/or incomplete personal information provided -- true verification can only be guaranteed by fingerprint process -- the inquirer has agreed to indemnify the reporting organization for any damage arising from the use of this information, and this report is furnished in reliance upon that indemnity -- this report is provided for informational purposes only -- this organization does not recommend for or against the hiring of an individual(s) based solely upon this information -- this information must be used in accordance with Federal and State laws. F.S. 119.01 If you will be paying by credit card, please fill in the following information: Your name exactly as it appears on the credit card: Credit Card Number: Expiration Date: 3 Digit Code (on the rear of your credit card) When you click the "Submit" button below, your information will be eMailed to us for processing your order.  The results will be made available to you within 3 - 5 days via e-mail.   Thank you for using CriminalScreening.com We look forward to the pleasure of serving you! E-mail address to send report to: