PMAA Member – New Client Set-Up Form Please Complete and FAX to 800-844-2722 PMAA Member Information: Member Name______________________________________________________________________ Address____________________________City________________________State ___  Zip_________ Billing Address: ____Same As Above OR Address____________________________City________________________State ___  Zip_________ Phone_____________________Fax_________________________Email________________________ Primary Contact_______________________________ Title__________________________________ Billing Contact________________________________ Title__________________________________ # of Employees ______     Approximate Annual Employee Turnover Rate ______% Employment Screening Services: We expect to order the following Employment Screening Services: SCREENING LEVEL APPROXIMATE # OF ORDERS PER YEAR Criminal Records        Statewide Criminal Records ________      County Criminal Records ________      Other Statewide Criminal Records ________      Other County Criminal Records ________      Nationwide Federal Courts Check ________ Driving Records (MVRs)        Driving Records (MVRs) ________ Application Verifications        Previous Employment History ________      Verify Education ________      Professional License & Credential Checks ________      Personal and/or Professional References ________ Identity/Credit        Social Security # and Address Confirmation ________      Employment Credit Reports ________ Ordering/Result Reporting Details (check all that apply): Ordering EMPLOYMENT SCREENING (check all that will apply): ___We will order screenings via the LABORCHEX website ___We will FAX orders ___We will Mail orders Receiving/Reviewing EMPLOYMENT SCREENING Results (check all that will apply): ___We will check the website           NOTE: Most LABORCHEX clients that use the website to order screenings and receive/review           results also choose to receive results via Email or FAX. ___Email results to persons indicated below ___FAX results to persons indicated below ___CALL before FAXing Employment Screening Contacts: Name:___________________Email:___________________Phone:____________FAX:____________           ____Order Screenings ____Receive Results ____BOTH Name:___________________Email:___________________Phone:____________FAX:____________           ____Order Screenings ____Receive Results ____BOTH Name:___________________Email:___________________Phone:____________FAX:____________           ____Order Screenings ____Receive Results ____BOTH Name:___________________Email:___________________Phone:____________FAX:____________           ____Order Screenings ____Receive Results ____BOTH (please use a separate sheet for additional names)