Free Annual File Disclosure

Consumers may request a free annual file disclosure pursuant to the Free Annual File Disclosure Rule, 16 C.F.R. Part 610, by filling out the form below. ONLY FILL OUT THIS FORM IF YOUR BACKGROUND CHECK WAS CONDUCTED BY employeescreenIQ

Name: *
Address 1: *
Address 2:
City: *
State/Province: *
Zip/Postal Code: *
Phone: *
Email: *
Employer who ran background check: *
Date of Birth: *	ex: 03/22/1979
Social Security Number: *	- - ex: 123-45-6789

> fields with the * are required