Point of Contact Information Form Contact Information: (Physical location required) Agency/Company Name: Address: Street :
City:
State:
Zip:
Contact Information: Primary:
Title:
Telephone:
Email:
Secondary:
Title:
Telephone:
Email:
Other:
Title:
Telephone:
Email:
State:
Zip:
Billing Information: (if different than above) Agency/Company Name: Address: Street :
City:
Telephone:
Fax:
Email:
Primary Contact:
Title:
Email:
Secondary Contact:
Title:
Email:
Additional Notes: May we contact your applicant(s) for additional information: Yes □
No □
HR TruCheck, Inc
3525 Highway 138 SW, Stockbridge, Ga. 30281 ~ Phone (866)-773-3675 ~ Fax (866) 760-1878 ~
[email protected]