Monthly Billing Registration Form

This order form is disabled because we are no longer providing eviction record services at this time. Thank you for your business and support throughout the years. For those in need of criminal background records, we will continue to offer criminal background record check services through our sister website - https://www.instantcriminalchecks.com. For tenant screening providers, we recommend visiting the website for the Professional Background Screening Association (https://thepbsa.org). Again, we very much appreciate your support over the years.

Contact Information:

First & Last Name

Title:

Phone Number:
[Phone extension is optional]

Ext:

E-Mail Address: [this is also your username]
[You need to enter your e-mail address twice]

Re-type
Email:

Password:
[You need to enter your password twice]

Re-type
Password:

Website Address:
[Optional]

How did you find us?
[Optional]

Yes, I want to receive email about new products, specials and industry news!

Business Information:
Company/Legal Business Name:
DBA: ["Doing Business As" name is optional]
Street Address:
City:
State & Zip Code:
Business Phone Number: [business phone extension is optional]	Ext:
Federal Tax ID# (EIN): [description]An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number, and is used to identify a business entity. Generally, businesses need an EIN. You may apply for an EIN in various ways, and now you may apply online. Simply go to www.irs.gov and then click on the “Online EIN Application” link to apply for an EIN if you do not currently have one… For sole proprietorships the social security number (SSN) can be used as an EIN.

Mailing Address:
My Mailing Address is the same as my Business Address above
Street Address:
City:
State & Zip Code:

Monthly Billing Options:
As part of our approval process, you must place at least 1 order using a credit card or mail us a check for $100

1: Credit Card
Please bill my credit card at the end of each calendar month.

2: Pay By Check - You will be invoiced with Net15 payment terms

I will process an order using a credit card

I will mail you a check for $100

Credit Card Information:

Cardholder Name:
[Enter name exactly as appears on your card]

Card Number:
[no spaces or hyphens]

Expiration Date:

Street Address:

City:

State & Zip Code:

PayPal Payment Information:

Your Full Name:

Google Checkout Payment Information:

Your Full Name:

Please make your $100 company check payable to Screening Intelligence LLC and mail it to:
Screening Intelligence LLC
EvictionRecords.com
75 Arlington Street, Suite 500
Boston, MA 02116
After we receive and deposit your company check, an account representative will contact you.

Billing Information:

My Billing Information is the same as my Contact Information

First & Last Name :

Billing E-Mail Address:
[You need to enter your e-mail address twice]

		Re-type Email:
	Please only send monthly invoices to this email address.

Billing Phone :
[phone extension is optional]

Ext:

*By submitting your registration information and typing the word "AGREE"
you are indicating your acceptance of our Terms of Use and have read and understand our Privacy Statement. Your submission of this form will constitute your consent to receive required administrative and legal notices electronically.
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