Concierge Services Application - National Fingerprint

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Concierge Solutions

Standard Concierge Price $298 Complete per person fingerprinted

Multiple persons may be printed simultaneously at the same location. USPS Express Mail delivery included.

Your concierge will contact you to arrange the fingerprinting appointment using the information provided below. Please provide accurate contact information for normal business hours.

After completing this form you will be taken to PayPal for secure checkout. If you have questions prior to checking out, please call 888-8BE-SURE or click here to ask a question by email.

Concierge Application

Service Level

PURCHASOR INFORMATION Please enter the information for the PURCHASOR (individual or company control agent purchasing the Concierge session)
Purchasor's Full Name*
Company Name
Address*
Suite
City*
State*
Zip Code*
Country
Email*
Verify Email*
Primary Phone (ex: 555-555-1234)*
Mobile Phone*
-	A mobile phone is required in case of emergency
CONCIERGE ORDER This information is required about the persons to be fingerprinted, reasons for fingerprinting, and regulating agency (if known) through whom the confidential FBI results must flow.
Agency Selector*
Purpose/Reason for Fingerprinting (And AGENCY if "other" is selected above)*
Instructions	IN ABOVE BOX, state REASON or PURPOSE for fingerprinting. Examples: Employment-related, Certificate-renewal, licensing, volunteering, adoption, etc. IF YOU SELECT "OTHER" IN AGENCY FIELD Also include the federal, state or organizational agency. Examples: AHCA, Medicaid, FOFR, DBPR, DOEA, VECHS, USCIS, Diocese of … , etc. For State Agencies, include State Name
Broker Dealer*
Recipient of Results
Instructions	In above box, describe in plain words if you already know who is to fetch the results from whom. Otherwise leave blank. Examples: Employer fetches from agency. I expect results to be mailed to me. I am the compliance officer who gets the results.( 50 characters max.)
Number to be printed*
Instructions	Enter the TOTAL NUMBER OF PERSONS TO BE FINGERPRINTED in the box above. *After submitting this form, enter this number as the quantity in the Virtual Terminal when making your purchase.*
Persons providing prints*
Instructions	In above box, list the name(s) address(es) , mobile/personal telephone number(s) and any needed reference number(s) (such as Medicaid Provider or NMLS license) of persons providing prints. *NOTE:* It is OK to reserve spaces for persons not yet known by entering “Applicant 6, Applicant 7”, etc. Reply to your confirmation email to add contact details. Incomplete or inaccurate information will cause delays. You may also phone 1-888-8BE-SURE with corrections (leave voicemail if necessary).
FINRA Requrements	In order for you to use concierge services your compliance officer must complete and mail the EFS Broker Dealer Participation Agreement Form. See instructions in the form.
Name of FSO*
OPM Requirements	FSO must have access to SWFT.
Service Terms	By submitting this form, you agree to NFp's Standard Terms of Service.

* Required

For immediate questions, please call 1-888-823-7873, or click here to email.

Concierge Solutions

Concierge Application

CUSTOM-Expedited