FAX TO: FROM:
Company: LexisNexis / Name:Attn: Luis Campos / Church:
Fax Number: 970-622-4707 / City, State:
Regarding: Background Screening / Phone:
No. of pages (including cover): / Group Publishing Acct No.:
In the event we cannot reach you at your Church phone number, please provide additional contact information and include the best time to call.
Mobile Phone: / Other Number(s):
Best time to be reached:
Thank you for choosing Shepherd’s Watch for your background checks, which are provided by our partner LexisNexis.
Please complete, sign, and fax these items:
· ALL pages of the completed and signed LexisNexis Screening Solutions Application & Agreement Form (account activation form).
· ONE of the following three items are required:
o 501c3 Certification (issued by the IRS)
o Articles of Incorporation (all pages please)
o Federal Tax Exempt Certificate along with the Declarations Page of your Insurance Policy
NOTE: If you cannot provide a copy of the Federal 501c3 Certificate from the IRS, the Federal Trade Commission (FTC) requires LexisNexis to perform a brief site inspection of your office.
The entire activation process can take up to seven business days once LexisNexis has received the completed application and all required business documentation. Plan for an additional three days if a site visit is needed.
Once the activation process is finalized, the Account Administrator(s) will receive a welcome email from LexisNexis about obtaining their User ID and log-in information. You’ll also be invited to attend a conference call training, or 24/7 on-line training. The training is highly recommended and both options are a great way to become familiar with how to place background check orders using the LexisNexis system.
We appreciate your time as you go through the activation process and we look forward to fulfilling your risk management needs!
Questions: Contact: Starr Smallwood at 678-694-3461. Monday – Friday, 8:00 a.m. to 5:00 p.m EST.
(April 2012)