STEP 1	Enter Subject's Information
STEP 2	Enter Your Information
STEP 3	Enter Billing and Return Information

Order Form Step 1 Subject Information (*Required) *First Name *Last Name Middle Initial *Social Security Number *Date of Birth *State *Drivers License Number -------------------------------------------------------------------------------Step 2 Client (Your)Information (*Required) This information is not shared with the general public and must match the credit card you will be using. *Your Name *Company (If self, please indicate) Title *Email *Address *City *State *Zip Code *Phone *Fax Number -------------------------------------------------------------------------------Step 3 *What is your permissable purpose? Choose One Consumer's Request Employment Screening Insurance *How would you like your reports returned? Choose One Email Fax US Mail (Additional 5 Days) *Credit Card Number *Credit Card Type Choose One Visa Mastercard Discover Amex *Expiration Date *Name on the Card Client hereby certifies that no report shall be ordered from Accurate Credit Bureau except in strict compliance with the Fair Credit Reporting Act (FCRA) and any and all other applicable federal or state laws. By clicking on submit, you authorize Accurate Credit Bureau Records Search to charge your credit card for the total amount of services requested. All driving record searches are non-refundable. The availability of driving record information varies from state to state. Your IP address will be recorded. Yes, I would like to receive updates and product info from you in the future. -----