Required for Search and Retrieval

eMail Address  
Daytime Phone  
Fax Number  
 I do not have email or fax 
Credit Card #  
Expiration Date     /  
Credit Card Type  
Name on Credit Card 
(Ex: John W. Smith)


Search Information
Note: A Social Security Number is an integrated part of any background investigation. CIR Inc., the parent corporation behind this WEB site, is a licensed professional private investigation firm and is committed to keeping your information both private and secure. All sensitive information we collect is encrypted and stored on our internal secured server. If you do not wish to put your SSN on this form, an additional $3.00 charge will be added to your invoice in order to recover the cost of retrieving this information from outside sources.
 
First Name  
Middle Name  
Last Name  
Suffix  
Sex   Male   Female
Date of Birth   / /
Social Security #  
Driver's License #  
State of Issuance  


List any OTHER name used in the last 7 years:

Maiden names, other married names, alias, aka (As Known As) fka, (Formerly Known As), nicknames, legal change of names, etc. will be searched. Hyphenated surnames, such as John Smith-Jones, will be searched as John Smith-Jones, John Smith, and John Jones. Please provide as accurate date as possible as to when and where a name was used. YOU WILL BE CHARGED FOR EACH NAME SEARCHED IN EACH JURISDICTION. We do not want to conduct searches where a name was not used, accurate dating will help us. We try to provide lower pricing for akas.  Your estimated cost may not reflect all alias searches that will be performed. If you need an accurate cost, please send us an email requesting "price with aka fees".


 

Full Name  
Dates: From  
To  

Full Name  
Dates: From  
To  

 
Full Name  
Dates: From  
To  


List ALL addresses for the last 7 years:

  Current Address
Dates: From  
To  

Present
Street Address  
City  
County  
State/Province  
Zip Code  
Previous Address 1

 
  Previous Address 2
Dates: From  
To  

Street Address  
City  
County  
State/Province  
Zip Code  
Previous Address 3

 
  Previous Address 4
Dates: From  
To  

Street Address  
City  
County  
State/Province  
Zip Code  
Previous Address 5

 
  If you have additional addresses, please place the city and state below:
  City  
  City  
  City  
 
    Comments/Special Instructions:
   
 
Important:  Please verify your email address and phone number
are correct before submitting this form!!!
WE WILL NOT PROCESS THIS REQUEST, WITHOUT ELECTRONIC SIGNATURE (OR A SIGNED RELEASE) I hereby state that the information I have provided to Carolina Investigative Research (CIR) is true and correct. I authorize CIR to conduct a criminal record search and address trace on myself. This background check is for

Electronic Signature,
By typing my name I acknowledge this is my legal mark.

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