Company / Billing

Background Check Selection & Payment

Type of Check

[radio* chk_type use_label_element default:1 "BCI only" "FBI only" "BCI and FBI"]

Payment Method

[radio* payment_method use_label_element "Credit Card" "Pay at appointment" "Invoice"]

[acceptance* invoice_terms]
I agree to monthly billing terms: invoices are due 45 days after the statement date; a $25 late fee applies every 30 days past due until paid in full.
[/acceptance]

Applicant Information

[group fbi_fields]

FBI Attributes (required for FBI checks)

[/group]

Release & Authorization

[acceptance* release]
I authorize Premier Choice Health Services, LLC to obtain criminal history information from BCI&I and, if requested, the FBI, and to release that information to the agency/company/individual indicated above. I release BCI&I and connected individuals from liability related to the dissemination of this information.
[/acceptance]

By submitting, you confirm all information is accurate. Do not submit from a public device.