Applicant's Physical Description

Social Security Number

Date of Birth

Place of Birth

Country of Citizenship

SEX:

Race:

Weight

Height

Eye Color:

Hair Color:

Do you need to add another client for fingerprinting?

First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

SEX:

Race:

Weight

Height

Eye Color:

Hair Color:

Social Security Number

Date of Birth

Place of Birth

Country of Citizenship

Reason Enrolled

State law requires two forms of valid identification: One MUST BE PROOF OF YOUR SOCIAL SECURITY NUMBER. We will not process your fingerprints without valid proof. Which document will you bring to your appointment?

I have read and agree that the ORI number is correct and accurate.

**Important Notice Regarding Fingerprinting Services**

Please Read: Your name MUST match the same name entered for your licensing, or you will delay the licensing procedure. DBPR and all Florida licensing agencies may also deny your fingerprints. If you enter a different name from the name submitted during fingerprinting, Miami Beach LivesScan Fingerprinting is not responsible for your application being denied or delayed. Miami Beach Livescan Fingerprinting is also not responsible for any fees incurred for any licensing resubmissions.

Please be informed that all fingerprinting services are non-refundable. It is crucial to verify your Florida Ori Code (Agency Code) with your employer or licensing agency, as well as your Finra Broker Company and ATF Eform number. Inputting incorrect data may necessitate redoing your service. We strongly urge you to double-check all the information provided to ensure accuracy and prevent any inconvenience. Your attention to these details is appreciated.

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Payment Method

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No payment - ( Mobile Services are Prepaid ) I Prefer Walk In Services | We offer every Wednesdays (10am -1pm) (No confirmed appointment)

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