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Community Name
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First Name
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Middle Name
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Last Name
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Current Address
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Zip Code
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Phone Number
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Mobile Phone
Email Address
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DOB
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SSN / SIN
*
Have you ever been arrested before?
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--- Select Choice ---
Yes
No
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Disclosure / Authorization
Disclosure
AmeriCheckUSA may search for personal information on you, in regard to your current application for residency, through various databases, which may include, but not limited to, Criminal Records, Eviction Records, Bankruptcies, Liens, Judgements, Lawsuits, etc. AmeriCheckUSA may also obtain a copy of your consumer report, also known as a credit report, through various credit reporting agencies such as Equifax, TransUnion, Experian, which may include your FICO score. AmeriCheckUSA may also conduct personal interviews with your current or prior employers, current or prior landlords, neighbors, friends, or associates to verify information which was submitted on your application. AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.
Authorization
By signing below, you agree that you have read and understand the foregoing disclosure and hereby authorize AmeriCheckUSA to conduct a full and complete residential background check as described in the above disclosure. You further authorize that AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.
Todays Date
SSN Name Zip
Your Name
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Name (One Person Per Form)
Your Signature
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Clear Signature
Signature (One Person Per Form)
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Identification
We require a copy of your Driverβs License and Social Security Card to verify your name, address, date of birth and social security number.
Upload Government Issued ID (Driver's License, Passport, etc)
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Upload Government Issued Social Security Card
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Payment Required
Visa, MasterCard, AmEx and Discover accepted
Background Check
Price:
$30.00
(plus 3% processing fee)
CC Processing Fee
Total
$0.00
Credit Card Payment
Name on Credit Card
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Name on Background Check
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Credit Card Payment
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SUBMIT
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