Accurate Biometrics Application Accurate Biometrics
Phone: 773-685-5699 Fax 773-685-5433
4849 N. Milwaukee Suite 101
Chicago, IL 60640
Website: www.accuratebiometrics.com
National Louis University UCIA Thank you for choosing Accurate Biometrics for your fingerprinting needs. PLEASE PROVIDE THE FOLLOWING INFORMATION (Please print clearly.)
Last Name: First Name: Middle Initial:
Daytime Phone:
Date of Birth: Sex: (circle one)
Male
Female
Race: (circle one) Black
Hispanic
Asian
White
American Indian/Alaskan
REQUESTER INFORMATION
Name: ___________________________________ Agency Name: < not applicable > Street Address: _____________________________________________________________ State: ________________________________ Zip Code: _______________________ I, the undersigned, authorize Accurate Biometrics to capture and transmit my fingerprints and above- noted demographic data to the Illinois State Police. I understand that the Illinois State Police will return the results of the fingerprint search to the Requestor listed above. Signature: _____________________________________ Date: _____________________ ------------------------ (Do Not Write Below This Line. - - - For Office Use Only) ---------------------- F.P. Tech: __________________________________ TCN: ___________________________ Date Fingerprinted: ______________________________
51 / MAT (Program) Handbook
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