Customer Information Form Please enable JavaScript in your browser to complete this form.Company/Organization Name *The name of your company or OrganizationTrade/DBA NameYour "doing business as" name. If different from your Organization's name.Type of Business *A brief description of your business.Type of EntityCorporationPartnershipLLCLLPSole Proprietorship501(c)OtherType of EntityIf Other Please specifyOther type of EntityState of Organization Filing *N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState where organization papers are filed.Stock SymbolIf publicly traded, your company's stock symbolMain Address *Main Address Line 2Main Address City State Zip *WebsiteURL of the organization's websiteMain Phone # *Companies Main Phone #How long in Business? *Length of time company or organization has been in business.Is your business/organization licensed? *YesNoN/AState of License *N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState where organization papers are filed.Type of LicenseType of license for the organization.Reasons for Background Screening Reports *Pre-Employment ScreeningTenant ScreeningVolunteer ScreeningDOT ComplianceCredit ApplicationsLicensing/Regulatory ComplianceOtherChoose all that applyIf Other Reason please specifyTrade References *Please enter the Name/Phone #/Description of at least 3 trade references.Contact Name *FirstLastName of Individual submitting this informationContact Title *Title of the individual submitting this informationContact's Email Address *Email Address of the individual submitting this information.Contact's Phone # *Phone # of the individual submitting this informationPhoneSubmit