Level 2 Miscellaneous Payment Form - Level 2 Background Screening Services

DUE TO THE CURRENT PUBLIC HEALTH CRISIS MASK REQUIRED FOR ENTRY!

NO ENTRY FOR CUSTOMERS WITH ANY OF THE FOLLOWING SYMPTOMS:

COUGH, SNEEZE, SORE THROAT, RUNNY NOSE, FEVER, ANY COLD/FLU TYPE SYMPTOMS

Use this form to make a general payment that was requested by Level2 Background Screening Services LLC. This area is NOT for appointment purposes. Level2 Background Screening Services LLC does not provide refunds, or refunds for missed appointments, however; for those that miss appointments, the customer can reschedule and pay a reschedule fee.
Name of person/people being screened:*

You can list multiple people here, separated with a semicolon.
ORI NUMBER*

(Where your results will be sent). This is required.
Contact Person:
Contact Phone #*
Reason For Payment*
Miscellaneous payment is for:
Qty*
Total Payment*

Level 2 Live scan Screenings are $100 each plus tax.
Total Charge:
$0.00
Credit Card*
Card Details
Cardholder Name
Credit Card Billing Info*
ZIP / Postal Code
Send Receipt to This Email Address*
- As the holder of the above listed credit card, I request that the above fees be charged to my credit card.
Signature