Fingerprint Card Request Form

*FINGERPRINT CARD REQUEST FORM FOR ENVIRONMENTAL BACKGROUND INVESTIGATION UNIT (EBIU) INVESTIGATIONS ONLY Fingerprint cards, both Federal and State, are available by request. Please complete the form in its entirety and submit a facsimile to (614) 644-9684 or mail to: Environmental Background Investigation Unit 30 E. Broad Street, 25th Floor Columbus, Ohio 43215 Total Number of Cards Requested: Total Number of Federal Cards: Total Number of State Cards: NOTE: Each individual who has not previously submitted fingerprint cards to the Environmental Background Investigation Unit must complete and submit a federal and state fingerprint card. Please indicate below the contact person to whom the cards are to be mailed. (Contact Person) (Company Name) (Street Address) (City, State, Zip Code) (Telephone Number) *This request form is only for companies gEnvironmental Background Investigation process. Any other fingerprint card requests should be directed to: Bureau of Criminal Identification and Investigation P.O. Box 365 London, Ohio 43140 (740) 845-2000 American LegalNet, Inc. www.FormsWorkFlow.com