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Provide Consent Form Info Prior to your appointment

All Fields Must Be Completed:

First Name:

Middle Name:

Last Name:

Email Address:

Street Address:

City:

State:

Zip Code:

Select Gender:

Select Race:

Select Hair Color:

Select Eye Color:

Height:

Weight:

Birthday:

Place of Birth (State or Country if Applicable):

Phone: (no symbols or spaces)

Do you agree to provide your personal information to A Top 5 Percent Fingerprinting, LLC. Your information will only be used to prefill any necessary paperwork prior to your fingerprint appointment? A Top 5 Percent Fingerprinting, LLC will not submit or sell any of your personal information without your signature which you will have to provide in person at our brick and mortar agency.

Yes I agee to provide my information to office personnel only