Personal Report Order Form:

If you have any questions or need assistance with this process, please call:
Customer Service toll free at 1-888-282-0447.
We are here to serve your needs.

If you want us to start immediately, fill out the form below and fax it along with a clear copy of your drivers license for identification, to the
Toll Free Fax number 1-888-286-7128.
(Be sure to include your phone number for faster service.)

Your order will be processed immediately after you fax in the signed order form, along with a clear copy of your drivers license. A personal credit report can be faxed back to you in about 1 hour.

You may contact your customer service representative by calling toll free 1-888-282-0447 to verify that you have all the information required. The representative will also provide an exact quote and delivery time for any additional services you need.

Select the print option on your browser to print this form after filling out the fields. Sign the form and fax it along with a clear copy of your drivers license to
1-888-286-7128.

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AAA Credit Screening Services

Personal Report Order Form

Please PRINT your FULL name here:

This agreement is between AAA Credit Screening Services, L.L.C. and the Client whose signature(s) appears below.

• Client agrees that the credit reports or other report(s) ordered under this service agreement are solely for purposes allowed under the Fair Credit Reporting Act, 15 U.S.C. 1681 et seq. ("FCRA") including one or more of the following (check all that apply) : extending credit, review or collection of an account, employment purposes, underwriting insurance, in connection with some other legitimate business transaction (Please specify in space provided: )
• Client understands that the information on the credit reports and other reports provided under this agreement is not guaranteed to be accurate, but is reported as supplied by third party sources.
• Client signature(s) below is(are) certification that Client(s) understand that anyone who knowingly and willingly obtains information on a consumer from a consumer reporting agency under false pretenses (illegally) may be fined up to $5,000 or imprisoned up to one year under Title 18, United States Code.
• Client(s) agree(s) to the use of their credit report for the purpose of verifying Client identity.
• Client agrees to release and indemnify AAA Credit Screening Services, L.L.C., as well as their officers and employees, from all liability arising from the Client's unauthorized access, improper use, or reliance on consumer credit information and any other information provided by AAA Credit Screening Services, L.L.C. pursuant to this agreement. Client further agrees to release and indemnify the credit bureaus and other information suppliers (used by AAA Credit Screening Services, L.L.C. to provide consumer credit information and any other information) as well as their parent, sister, and affiliate entities, their officers, employees, contractors, and agents from all liability arising from the Client's unauthorized access, improper use or reliance on consumer credit information and any other information provided by AAA Credit Screening Services, L.L.C. pursuant to this agreement.
• Client agrees that there are no written or oral understandings that are not fully expressed in this agreement.

Please select the type(s) of report(s) you wish to order:

CREDIT REPORTS

Individual Credit Report $26.52

Joint Credit Report - for you and your spouse $37.35

CRIMINAL BACKGROUND REPORTS

Countywide Criminal Check (1 U.S. County) $29.00/county

Indicate County/State(s) to perform criminal check in:
County State
County State
County State

Statewide Criminal Check (where available) $29.00/state

Indicate State(s) to search for Criminal Record(s):
State State State State

Your Full Name:

Your Date of Birth (MM/DD/YYYY):

Your Social Security Number:

To allow us to verify your identity, please enter the first 6 digits of a home loan, auto loan, gas, store, debit, or credit card:

Your Signature Authorizing
AAA Credit Screening to obtain your report(s):

Spouse's Full Name:

Spouse's Date of Birth (MM/DD/YYYY):

Spouse's Social Security Number:

To allow us to verify spouse's identity, please enter the first 6 digits of a home loan, auto loan, gas, store, debit, or credit card:

Spouse's Signature Authorizing
AAA Credit Screening to obtain spouse's report(s):

Street Address:

City, State, Zip:

E-mail address:

Do you want us to call you before sending your report?
Yes No

How do you want your report returned to you?
By Fax
By Mail (Sent to address above)

Fax Number (including area code):

Date:

Payment/Billing Information

Please select your method of payment
Check Draft (Fax a copy of your completed check to us)
Money Order (Order processed when we receive. 2-ID's Required.)
Master Card
Visa
Discover
AMEX

Credit Card Account #:

Expiration Date:

Check Draft? Enter the numbers on the bottom of your check:
( 9 Digit Transit# ) ( Account# ) ( Check# )


Name (as it appears on credit card or check):


Address (of Cardholder or Bank Account Owner):


City/State/Zip:


Daytime phone#:

Fax#:

Home phone#:


*Signature (of cardholder or account owner)
authorizing billing for report(s) ordered above:


Please provide the appropriate phone number to allow us to verify your bank or credit card account information (required):

*Credit Card Phone Number (On Back of Card):


*Bank (Checking Account) Phone Number:


If you want us to draft your checking account for payment (minimum balance of $100 required), you must select "Check Draft" as the method of payment above. Make sure you include your bank phone number as requested above. Make your check payable to "AAA Credit Screening Services." Write "O.K. to draft for amount on check" on the memo line of your check. You will need to fax a copy of the check to us at 281-286-7128 or toll free at 1-888-286-7128. We will use the copy of your check to draft your account for payment. Put the amount in your check register. You do not need to mail the original check to us.

*All Orders MUST include your signature(s) and a copy of your driver's license(s) to be processed. Third party billing is allowed only with a signed authorization from the third party as well as a copy of the third party's driver's license. Thank you!