Online Payment - Level 2 Background Screening Services

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Please use this form to pay for your Live Scan Level 2 fingerprinting appointment. The cost is $100 plus applicable local sales tax per screening. Important: Level2 Background Screening Services LLC does not issue refunds for missed appointments. However, if you miss your appointment, you may reschedule by paying a rescheduling fee.

Person being screened:*

Contact Phone #*

Level 2 Live scan screening location*

Level2 Jacksonville – 1626 Camden Avenue

Level2 Riviera Beach – 4910 Dyer Blvd

Level 2 Live Scan screening cost includes required State of Florida sales Tax

ORI Number*

Agency where your results are to be sent. For example, EAHCA020Z is used by AHCA. Contact your employer or licensing agency for this number.

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How Many People Are You Paying For:*

Enter the number of screenings

Screening Total Charge:

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*

Customer Signature

After YOUR registration has been submitted, you will be allowed to set your appointment date, time and location of your choice, depending on availability

Name

This field is for validation purposes and should be left unchanged.