Step 1 of 7 14% Total $0.00 Let's get started! Please be as accurate and thorough as possible to avoid processing delays. Skip To The Front Of The Line! Let Us Hand Deliver Your Package To The D.B.P.R! Option Available When You Check-Out! Need To Register Your Out-Of-State LLC/Corp? Need Help Starting A New LLC/Corp? Need To Make An Amendment To Your LLC/Corp? Call Us We Can Help! Please Enter Who We Should Contact Regarding This Report, The Email Address used here is where we will email the report when finished. We will not mail a package via mail unless you ask for it at the end or it is required by a county. Any Questions About This Process Please Call 1-800-600-2155 This form will allow you to order 2 personal reports and 2 business reports, if you need more then 2 please submit another application.PLEASE READ!!!*ATTENTION: By reading this section it will save you time and confusion over the order form and process. 1st UNITED CRS WILL NOT BE HELD RESPONSIBLE FOR DELAYS IF YOU DO NOT PROVIDE ALL INFORMATION REQUESTED IN THE APPLICATION. This application will allow you to order up to 2 PERSONAL REPORTS and 2 BUSINESS REPORTS. PLEASE DO NOT USE AUTOFILL IN THIS APPLICATION, as it may fill lines in incorrectly). The personal section is first, if you are in need of only the business report just click next through the options (automatic response is No Thanks I don't need a personal report) until you get to the business section. Please go through the application carefully. Many times on our application, Google will auto fill lines. Anything auto-filled can slow down the report process. Double check SS# and DOB on the personal section. **DO NOT USE ALL CAPS when filling out lines. Doing so may delay your report. IF YOU ARE ORDERING REPORTS AND YOU GET ALL THE WAY TO THE CHECK OUT AND YOUR TOTAL IS $0.00, THIS MEANS NO TYPE OF REPORT WAS SELECTED. PLEASE TAKE YOUR TIME AND MAKE THE CORRECT SELECTION. It is very important that you make a selection. Default selection is "No thanks, I don't need a report." Please also verify your email as well when filling out the form. Please check to be sure there are no typos. If you do not receive an email immediately after you submit the application, chances are the email provided was incorrect. We will not be responsible for report delays if an incorrect email is supplied. *Once a credit report investigation begins it cannot be canceled or refunded. (example: If we email that the business is inactive in the states system.) Please take the time and be sure business is active or registered on SUNBIZ.ORG. Please verify that it is ACTIVE on their site, if the business registration was just submitted it can take 24-72 hours to show in their system. We will not be held responsible for delays in reports, regardless of rush services if the business not registered or is in the middle of registration. Please double check SSN and DOB on personal report application(s). Providing an incorrect SSN or DOB will result in delays and additional charges ($25.00) as the report will have to be re-run due to incorrect information provided to us. RUSH JOB ORDERS PLACED AFTER HOURS ON THURSDAYS AND FRIDAYS IN GENERAL OR WEEKENDS WILL BE DELIVERED MONDAY OR TUESDAY! Please understand security updates or file issues can cause delays beyond our control regardless of expedited service. ORDERS PLACED DURING WEEKENDS AND HOLIDAYS MAY HAVE DELAYS REGARDLESS OF EXPEDITED SERVICES. We do our very best to get reports turned around as quickly as possible, however delays can occur with any order which are beyond our control. *All orders in general* All orders placed after normal business hours (9-5, M-F) will begin processing the following business day. Orders placed over the weekend will begin process on Monday. *ONCE AN ORDER HAS BEEN PLACED AND INVESTIGATION HAS STARTED THE ORDER CANNOT BE CANCELED OR REFUNDED.* Any questions please call.Name*This is who we contact with any questions about this order, this does not have to be the person getting the report (You, Secretary, Office personnel, Wife, Husband etc.). *DO NOT FILL OUT COUNTY OR STATE LICENSING INFROMATION. There is a section at Checkout for county licensing email that can be filled out.**DO NOT USE ALL CAPS when filling out lines. Doing slow may delay your report. First Last Phone*Email* License Application Processing*Who are YOU using to process YOUR Licensing paperwork? This would be the actual application paperwork process, not just credit reports. If you are filling out your own State or County application, leave "MYSELF" as the selection.MYSELF1st UNITED CRSOTHER AGENCYCONTACTIf your are using 1st United CRS to handle your License Application paperwork who is your contact? County Licensing Email:If you need the reports emailed to a specific County licensing department, please provide it in the box below. Example: [email protected] Are you aware that we can help get your contractors license? Let us do the paperwork for you! Call (800) 600-2155 or Order License Expediting At The End of This Form! Need a Personal Report? IF YOU ONLY NEED A BUSINESS REPORT, CLICK NEXT THROUGH THIS OPTION, AND THE SECOND PERSONAL REPORT OPTION, TO ADVANCE TO THE BUSINESS REPORTS SECTION.Personal Credit Report with FICO Derived Score and Public Records Searched at County, State, and Federal LevelsPlease Make Your Selection Below* No thanks, I don't need a Personal Report. Yes, Florida Resident (In Florida 7 Years) $60.00 Yes, Non-Florida Resident (Out of State) $81.00 Personal Report ApplicationIf You Have a CREDIT FREEZE on Your File, Please remove it before continuing, There will be a $25 Charge to Re-pull your report each time. THIS CAN AND WILL NOT BE EXCUSED AND PAYMENT WILL BE EXPECTED BEFORE YOUR REPORT IS RELEASED!Applicant / Qualifier Name First, Middle , and Last name required. If you do not have a middle name , state "I have no middle name" in box. (DO NOT USE ALL CAPS, Not providing FIRST , MIDDLE and LAST NAME will DELAY PROCESS.)* First We need your FULL MIDDLE NAME (not just initial)*REQUIRED* (if you do not have a middle name, please type "I do not have a middle name". Last Suffix Social Security:*Please type with dashes example( 999-99-9999) Also, must be a US issued SSN**Please type with dashes example( 999-99-9999) Also, must be a US issued SSNBirth Date* MM slash DD slash YYYY Address:*DO NOT USE A P.O. BOX, Must be a physical address. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you ever had a bankruptcy filed against you?NoYesDate:* MM slash DD slash YYYY County:*Have you ever had a judgement filed against you?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Have you ever had a lien filed against you?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*I AUTHORIZE 1st UNITED CRS, LLC / UNITEDCRS.COM TO CONDUCT A PERSONAL CREDIT REPORT ACCORDING TO THE GUIDELINES OF THE FAIR CREDIT REPORTING ACT. I UNDERSTAND 1st UNITED CRS IS NOT RESPONSIBLE FOR INFORMATION LOSS FROM DIGITAL TRANSMISSION OR FOR INFORMATION CONTAINED IN REPORT AND IS UNABLE TO CHANGE ANY INFORMATION IN ANY CREDIT REPORT.*Applicant SignaturePlease type applicant's full name:*Disclaimer: Electronic signatures are just as legal and enforceable as traditional paper contracts signed in ink.Date* MM slash DD slash YYYY Need a Second Personal Report? This is for a Second SEPARATE Individual. IF YOU ONLY NEED A BUSINESS REPORT CLICK NEXT THROUGH THIS OPTION.*STOP PLEASE READ. This is for a second individual report. A refund WILL NOT be given if you fill your personal information out twice for the second report. Please Make Your Selection Below DO NOT FILL OUT (CLICK NEXT) IF YOU HAVE ALREADY ORDERED YOUR PERSONAL REPORT ON THE PREVIOUS PAGE, THIS IS FOR A SEPARATE INDIVIDUAL. No thanks, I am not in need of a second report. Yes, Florida Resident (In Florida 7 Years) $60.00 Yes, Non-Florida Resident (Out of State) $81.00 Second Personal Report Application (Second Separate Individual, Someone other than yourself.) IF YOU ONLY NEED A BUSINESS REPORT CLICK NEXT THROUGH THIS OPTION TO ADVANCE TO THE BUSINESS REPORTS SECTION.Just Like Before, If You Have a Credit Freeze on Your File, Please remove it before continuing, There is a $25 Charge to Re-pull. THIS CAN AND WILL NOT BE EXCUSED AND PAYMENT WILL BE EXPECTED BEFORE YOUR REPORT IS RELEASED!Applicant / Qualifier Name: First, Middle , and Last name required. If you do not have a middle name , state "I have no middle name" in box. (DO NOT USE ALL CAPS, Not providing FIRST , MIDDLE and LAST NAME will DELAY PROCESS.)* First We need your FULL MIDDLE NAME (not just initial)*REQUIRED* (if you do not have a middle name, please type "I do not have a middle name". Last Suffix Social Security:*Please type with dashes example( 999-99-9999) Also, must be a US issued SSN**Please type with dashes example( 999-99-9999) Also, must be a US issued SSNBirth Date* MM slash DD slash YYYY Address:*DO NOT USE A P.O. BOX, Must be a physical address. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you ever had a bankruptcy filed against you?NoYesDate:* MM slash DD slash YYYY County:*Have you ever had a judgement filed against you?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Have you ever had a lien filed against you?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*I AUTHORIZE 1st UNITED CRS, LLC / UNITEDCRS.COM TO CONDUCT A PERSONAL CREDIT REPORT ACCORDING TO THE GUIDELINES OF THE FAIR CREDIT REPORTING ACT. I UNDERSTAND 1st UNITED CRS IS NOT RESPONSIBLE FOR INFORMATION LOSS FROM DIGITAL TRANSMISSION OR FOR INFORMATION CONTAINED IN REPORT AND IS UNABLE TO CHANGE ANY INFORMATION IN ANY CREDIT REPORT.*Applicant SignaturePlease type applicant's full name:*Disclaimer: Electronic signatures are just as legal and enforceable as traditional paper contracts signed in ink.Date* MM slash DD slash YYYY Need a Business Report?*PLEASE BE SURE BUSINESS IS REGISTERED FIRST WITH THE FLORIDA DIVISION OF CORPORATIONS* If in doubt, please check on SUNBIZ.ORG under search records. REPORTS CAN AND WILL BE DELAYED IF BUSINESS IS NOT REGISTERED REGARDLESS OF EXPIDITED PAYMENT. Business Credit Report with Public Records Searched at County, State, and Federal Levels Please Make Your Selection Below**PLEASE BE SURE BUSINESS IS REGISTERED WITH THE FLORIDA DIVISION OF CORPORATIONS* Business must show ACTIVE and in GOOD STANDING. If in doubt, please check on SUNBIZ.ORG under search records. *ONCE AN ORDER HAS BEEN PLACED AND INVESTIGATION HAS STARTED THE ORDER CANNOT BE REFUNDED. IF BUSINESS IS NOT REGISTERED OR LISTED AS INACTIVE A REFUND WILL NOT BE GIVEN.* No thanks, I don't need a Business Report. Florida Business (In Florida 7 Years or New Business) $80.00 Non-Florida Business (Out of State) $101.00 Business Report Application:Corporation / LLC Name:*Doing Business As Name: *STOP!!* PLEASE READ* LEAVE BLANK UNLESS YOU HAVE ANOTHER BUSINESS NAME YOU GO BY FOR THIS BUSINESS!*STOP!!* PLEASE READ* NOT READING CAN DELAY YOUR PROCESS WITH THE STATE OR COUNTY! *LEAVE THIS SPACE BLANK IF YOU DO NOT HAVE A DBA (A DBA is a NAME OTHER THAN THE MAIN BUSINESS NAME, DO NOT PUT MAIN BUSINESS NAME ON THIS LINE). A $25 fee WILL be charged if a DBA has to be removed after the report has been completed and submitted to DBPR or county. * DBA's are ONLY included on reports if they are provided to us by you on our application. What you put on this line will also go on your report. FEIN Number*FLorida Document Number*PLEASE READ CAREFULLY. The document number is your Florida Business Registration Number. It begins with a letter and is up to 12 numbers/characters long. Example L20000000000. If the business is not registered to do business in Florida, it will need to be and can be done on sunbiz.org. DO NOT MAKE A NUMBER UP. Any number used other than actual document number will delay your process regardless of expidited payment.Business Phone*Business Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Has the company ever had a bankruptcy filed against it?NoYesDate:* MM slash DD slash YYYY County:*Has the company ever had a judgement filed against it?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Has the company ever had a lien filed against it?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:* Need a Second Business Report?* No thanks, I'm not qualifying a second company. Yes, Florida Business (In Florida 7 Years or New Business) $80.00 Yes, Non-Florida Business (Out of State) $101.00 Second Business Report Application:*PLEASE BE SURE BUSINESS IS REGISTERED WITH THE FLORIDA DIVISION OF CORPORATIONS* Business must show ACTIVE and in GOOD STANDING. If in doubt, please check on SUNBIZ.ORG under search records. *ONCE AN ORDER HAS BEEN PLACED AND INVESTIGATION HAS STARTED THE ORDER CANNOT BE REFUNDED. IF BUSINESS IS NOT REGISTERED OR LISTED AS INACTIVE A REFUND WILL NOT BE GIVEN.*Corporation / LLC Name:**PLEASE BE SURE BUSINESS IS REGISTERED WITH THE FLORIDA DIVISION OF CORPORATIONS* Business must show ACTIVE and in GOOD STANDING. Doing Business As Name: *STOP!!* PLEASE READ* LEAVE BLANK UNLESS YOU HAVE ANOTHER BUSINESS NAME YOU GO BY FOR THIS BUSINESS!*STOP!!* PLEASE READ* NOT READING CAN DELAY YOUR PROCESS WITH THE STATE OR COUNTY! *LEAVE THIS SPACE BLANK IF YOU DO NOT HAVE A DBA (A DBA is a NAME OTHER THAN THE MAIN BUSINESS NAME, DO NOT PUT MAIN BUSINESS NAME ON THIS LINE). A $25 fee WILL be charged if a DBA has to be removed after the report has been completed and submitted to DBPR or county. * DBA's are ONLY included on reports if they are provided to us by you on our application. What you put on this line will also go on your report. FEIN Number*FLorida Document Number*PLEASE READ CAREFULLY. The document number is your Florida Business Registration Number. It begins with a letter and is up to 12 numbers/characters long. Example L20000000000. If the business is not registered to do business in Florida, it will need to be and can be done on sunbiz.org. DO NOT MAKE A NUMBER UP. Any number used other than actual document number will delay your process regardless of expidited payment. Business Phone*Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Has the company ever had a bankruptcy filed against it?NoYesDate:* MM slash DD slash YYYY County:*Has the company ever had a judgement filed against it?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Has the company ever had a lien filed against it?NoYesHow many times?123Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:*Date:* MM slash DD slash YYYY County:* Courier & Postage:**ONLY SELECT HAND DELIVERY IF YOU HAVE TURNED IN YOUR APPLICATION AND HAVE APPLICATION #. Hand delivery includes hand delivery ONLY. Please be aware we cannot hand deliver just the reports. The state requires us to have either the application number, deficiency letter or the entire application to submit reports. If you DO NOT have any of the previous you may send us your application packet to turn in for you with your reports, but there is a filing fee due with packet. Email $FREE *BEST OPTION, we email reports to you to print off and send in with your application Hand Deliver to DBPR State Office $125.00 Courier *ONLY SELECT IF YOU HAVE TURNED IN YOUR APPLICATION AND HAVE APPLICATION # Application Number If we are hand delivering*Application Number If we are hand delivering* The state requires us to have either the application number, deficiency letter or the entire application to submit reports.Rush Job / other services. Need a rush job? We understand emergencies and treat them as such!*Most orders are done within a weeks time frame or sooner, however delays can occur. Orders are done in the order they come in. If you need it sooner *NOW* is the time if you are in a rush for your reports. We receive hundreds of orders weekly, PLEASE DO NOT call after only a few days, demanding your reports, if you did not pay for a rush service. RUSH JOB ORDERS PLACED ON THURSDAY,FRIDAYS OR WEEKENDS WILL BE DELIVERED MONDAY OR TUESDAY! ORDERS PLACED DURING WEEKENDS AND HOLIDAYS MAY HAVE DELAYS REGARDLESS OF EXPEDITED SERVICES. We do our very best to get reports turned around as quickly as possible, however delays can occur which are beyond our control. *All orders in general* All orders placed after normal business hours (9-5, M-F) will begin processing the following business day. Orders placed over the weekend will begin processing on Monday. *Once an order has been placed and investigation has started the order cannot be canceled.* Most orders are done within a weeks time frame or sooner, orders are done in the order they come in. If you need it sooner *NOW* is the time if you are in a rush for your reports. We receive hundreds of orders weekly, PLEASE DO NOT call after only a few days demanding your reports if you did not pay for a rush service. (If the rush order option is unavailable, it means it has been disabled due to high rush order volume). No, thanks, I don't need a rush job. 24-72 hours $105.00 We Drop Everything We are Doing For You! $255.00 Yearly Registered Agent Fee(Includes filing fees) $415.00 Annual Renewal Registered Agent Services $255.00 DBA REMOVAL/ADDITION $25.00 Where should we send to?*If reports need to be sent to the county by us, please provide email address of the county the reports are being sent to in the box below. Deselect All Send report back to me for my application Send report to: County Coupon For credit card purchases, a 4.2% processing fee is applied to your total.*Processing Fee Added Price: $0.00 ATTENTION! If you have gotten this far and your total is $0.00, that means you have not selected a report type or any other service. Please review. After All Services Selected & Fee, The Grand Total To Be Charged to You Is $0.00 Credit Card Authorization Form1st United CRS offers the option to pay by credit card. However we require your permission to debit your credit card.Company Name or Personal Name:*Credit Card Information* Our credit card transactions are all processed through Stripe. By signing this authorization form, you are authorizing 1st United CRS to process your credit card through Stripe on your behalf. The transaction(s) on your credit card statement should appear as "STRIPE *UNITEDCRS" or could be listed as a phone number only. Credit Card Charge Backs WILL Be Subject to a $35.00 Fee.Billing Address for Card:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number of Card Holder:*Card Holder's Name* First Last Card Holder Signature:*DUE TO PCI COMPLIANCE, ADDITIONAL CHARGES, CREDIT CARD CHARGE BACKS, ETC WILL BE BILLED IN A SEPARATE INVOICE Thank You For Your Business and Have a Great Day!NameThis field is for validation purposes and should be left unchanged.