Background Check Request

First Name *

Middle Name or Initial

Last Name *

ID Type *

ID Number *

Retype ID Number *

Social Security Number *

Retype Social Security Number *

Birth Date * +

Phone Number *

Gender *

Street Address *

City *

Zip Code *

County *

Email where you would like results sent *

Please list any other cities in Texas where you have been a resident. *

Please list any addresses, including COUNTY, where you have been a resident OUTSIDE the state of Texas, within the last 5 years. *

Ethnicity *

Race *

Other names used (married, maiden, etc.). If you have more than one entry, please separate by a comma (Johnson, Wallace, etc.) *

I confirm that all information provided above is true and accurate, to the best of my knowledge. *

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