MULTIPLE LOCATION DEALER SET UP INFORMATION
(Please complete this form for each location)
This form will need to be completed for each dealership location in order to set up your account for Drug testing, criminal history background checks and other pre-employment screening services.
Main Location Name:
(I.E. ABC Ford)
Other Location Name:
(I.E. ABC Honda)
Other Location Street Address:
City, State, Zip:
Phone:
FAX:
Other Location
Numeric Code:
Contact 1 Name:
Email:
Contact 2 Name:
Email:
Billing Info:
(Please complete if different than above)
Billing Contact:
Address: (If Different)
City, State, Zip:
Phone:
FAX:
Please call Glorybell Cordova or Larry O'Blander at 800.966.6909 or E-Mail larry@2dis.com or Glory@2dis.com if you have any questions about these services.
Comments or Special Instructions:
______________________________________________________________________________ Disclaimer And Terms Of Use
None of the information in this web site should be construed as legal or insurance advice.
All forms, policies, terms, information and procedures should be reviewed by your legal
counsel before being used in any way.
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