Please conduct the following search/verifications in regard to the individual or Business listed below (Check each search desired).

EMPLOYMENT SEARCH:

	Workers Compensation Claims		Education Verification
	Drivers License/Driving Record History		Past Employment Verification
	Criminal Conviction History, by County		Credit History
	Professional Good Standing Verification

GENERAL LEGAL SUPPORT SERVICES: (Check each service requested)

Driving Record: State(s)

Skip/Trace

Asset Search: (County of residence) or other

Employment Search

Civil History: In following Counties/States:

Criminal History: In following Counties/States:

Real Estate: In following Counties/States:

Additional Instructions/Information Requested:

Check One:

Proceed with the requested services immediately and invoice accordingly.

Please forward us a quotation for the services requested before proceeding.

Fax to us at (please include area code):

The undersigned authorizes Eagle Communications to obtain the information requested above on its behalf. The undersigned fully understands that Eagle Communications does not guarentee this information and is not responsible fo any inaccurate information.

Name:

Title:

Date:

From: Eagle Communications, Inc.

CONFIRMATION and ACCEPTANCE

The fee for the services you requested will be $____________. Please sign below to signify your approval, and fax to (216) 297-3203.

SUBJECT INFO   Check One:

Business

Individual

First:

Last:

MI:

DOB:

SSN(if individual) or Federal ID#:

Street Address:

City:

State:

Zip:

Employer (If known):

Employer Address:

City:

State:

Zip:

Phone:

Fax:

State of Incorporation: