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Company Name

   

Contact Person

   

Mailing Address

   

Mailing City

   

Mailing State

   

Mailing Zip

   
Click here if your billing info is the same as your mailing info.

Billing Address

   

Billing City

   

Billing State

   

Billing Zip

   

Email Address

   

Phone Number

   

 

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DISCLAIMER: Southeastern Loss Management is not responsible for the use of information obtained in the background report. Neither SLM Inc., nor its officers, accepts any liabilities regarding the outcome of a background check nor the data reported. Information entered into data sources is sometimes entered inaccurately, therefore leaving the results in error. Data received by means of this background report can not be relied upon as completely accurate. The client also agrees and understands it is their responsibility to have the applicant sign a waiver allowing their credit history to be accessed according the Fair Credit Reporting Act.
 

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