Place Your Order - Viewpoint Screening

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Required Package
The Division of Communication Disorders at University of Wyoming requires the following background check to be performed.
Background Check:	County Criminal Records (7 year history, all jurisdictions) Nationwide Sexual Offender Registry Healthcare Fraud & Abuse (OIG/GSA) US Patriot Act / OFAC Social Security Validation
Price:	$47.50
Verification:	Employment*
Price:	$41.95
Release Form:	You are required to print and fill out this Release Form. You must fax this form to Viewpoint Screening at 888-516-2444.
Attention:	*Employers and institutions charge a service fee for employment verifications. This fee has been included within your background check package price.
Total Price:	$89.45

I have read, understand and agree to the Viewpoint Screening Terms of Use and Refund Policy .

Upload Release Form
In order to obtain your employment information, it is required that THIS RELEASE FORM be: PRINTED (print this form off) FILLED OUT (fill the form out completely) UPLOAD (upload this form back onto site)	You cannot/will not be able to proceed with your order until this form has been completed and uploaded here. Upload a different File

Applicant Information
First Name^*:
Last Name^*:
Middle Name:
Alias/Maiden Name 1:	Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 2:	Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 3:	Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Social Security Number^*:	- - Please Note: If you have not been issued a valid U.S. SSN then enter all zeros (000-00-0000) instead.
Date of Birth^*:	/ / (mm/dd/yyyy)
Gender^*:	Male Female
Phone Number^*:	(111-111-1111)
E-Mail Address*: ^{Your email address will be your user name to log in. If you have placed a previous order, it is recommended to use the same email address to prevent separate logins. Separate logins will contain separate results / medical documents, and cannot be combined.}	Please make sure you are entering your correct email address. You will be unable to log in or receive communications from Viewpoint Screening if your email address is not valid. Type E-mail address. Re-type E-mail address. Please make sure you are entering your correct email address. You will be unable to log in or receive communications from Viewpoint Screening if your email address is not valid.

Current Residential Address
Address^*:
City^*:
State or U.S. Territory^*:	For an international address, select "International" and select the foreign Country name below.
Country^*:
Zip Code^*:	ZIP Code Look Up Tool Please Note: If you have an international address that does not require a Zip Code, please fill in "00000".

Payment Information

First Name^*:
Last Name^*:
Credit Card Number^*:
Exp. Date^*:	(MM/20YY)
CVV^* ?
Credit Card Type^*:
Contact Name (if business):
Email^*:	Payment receipt will be sent to this email
Phone Number^*:
Address^*:
City^*:
State^*:
Postal Code^*:
IMPORTANT: Please note that if you enter an address other than the one on file with the credit card's issuing bank, or an incorrect CVV code, Viewpoint Screening will deny your transaction for security purposes. Additionally, denied transactions may cause the funds to be held by your bank for up to 5 business days before being released back to the card. Error #20 indicates that you have not entered your credit card expiration date in the correct format. The date must be MM/20YY format. "Viewpoint LLC" will appear on your credit card statement. A Parent or Guardian's credit card will be accepted. They should be made aware of this transaction. A W-9 form will NOT be provided for any orders placed. WARNING: Your credit card will be charged $ 89.45 when you click "Next." This price is for the package that you selected. If you did not select the correct package, do not continue. Go back and select the correct package. You have agreed to the Terms of Use and Refund Policy and you understand that this fee is non-refundable under any circumstances. Any payment disputes may result in account removal. Do not click more than once or you may be charged multiple times.

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