LORI BOLTON & ASSOCIATES
P.O. BOX 1919
FORNEY, TEXAS 75126
972-552-3355                                                  972-564-1327(FAX)



YOUR COMPANY NAME_________________________________ ORDER DATE____________________
YOUR ADDRESS_____________________________ YOUR NAME______________________________
_________________________________________ YOUR PHONE_____________________________

SUBJECT'S NAME____________________________________ DOB___________________________
ADDRESS__________________________________ SOC. SEC. NO.__________________________
_________________________________________ D.L. NO._______________________________

CHECK SERVICES DESIRED:

___CRIMINAL HISTORY (PLEASE INDICATE WHICH COUNTY TO BE SEARCHED BELOW)
    ____DALLAS COUNTY ($5.00)
    ____COLLIN COUNTY ($5.00)
    ____TARRANT COUNTY ($5.00)
    ____DENTON COUNTY ($5.00)
    ____OTHER COUNTY(IES) ($20.00), PLEASE SPECIFY_______________________________
    ____FEDERAL CRIM. CHECK ($15.00), SPECIFY LOCATION___________________________
    ____TEXAS STATEWIDE CRIMINAL CHECK ($30.00)

___CIVIL LITIGATION HISTORY (PLEASE INDICATE WHICH COUNTY BELOW)
    ____DALLAS COUNTY ($5.00)
    ____COLLIN COUNTY ($5.00)
    ____TARRANT COUNTY ($5.00)
    ____DENTON COUNTY ($5.00)
    ____OTHER COUNTY(IES) ($20.00), PLEASE SPECIFY_______________________________

___DRIVING HISTORY (MVR), ($30.00)

___SOCIAL SECURITY NO. VERIFICATION (USEFUL IN DETERMINING UNDISCLOSED
     ADDRESSES AND ALIASES) ($10.00)

___EMPLOYMENT HISTORY VERIFICATION ($10.00 PER EMPLOYER.   PLEASE LIST
     EMPLOYERS ON A SEPARATE SHEET)

___EDUCATIONAL HISTORY VERIFICATION ($10.00)

___REFERENCE VERIFICATION ($5.00 PER REFERENCE.  LIST REFERENCES AND PHONE
     NUMBERS ON A SEPARATE SHEET)

___OTHER SERVICES AVAILABLE UPON REQUEST.  PLEASE CALL FOR DETAILS AND 
     PRICES

© 2005 Lori Bolton & Associates