Ink fingerprint intake form

Client Information

Full Legal Name (as shown on ID):

Date of Birth:

Month

Day

Year

Place of Birth (City, State, Country):

Social Security Number (if required):

Phone Number:

Email Address:

Government-Issued Identification

Type of ID:

Driver’s License

State ID

Passport

Other:

ID Number:

Issuing State/Country:

Expiration Date:

Fingerprinting Details

Number of Cards Requested:

Service Location

Office Visit

Mobile Appointment

Address (if mobile):

Payment & Acknowledgment

Service Fee Paid: $

Payment Method:

Cash

Card

Zelle

Other:

Payment is due in full at the time of service. All fingerprinting services are non-refundable once completed.

Client Acknowledgment & Release

I certify that the information provided above is true and correct. I understand that the fingerprinting service provider is not responsible for fingerprint rejection due to agency standards, poor print quality, or circumstances beyond their control. I release the service provider from any liability related to fingerprint acceptance or processing by third-party agencies.

Client Signature:

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date:

House of Eve – Professional Identity Services

(714) 856-1377 | eve@houseofeve.org

Discretion • Precision • Reliability