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info@msipi.com

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For your first screening request, two forms must be completed and faxed to us at 603-298-6080. They are the Services Agreement and the Consent/Request form. For all subsequent screening requests, only the Consent/Request form needs to be completed. Both forms may be printed from this website.

After we have received your Services Agreement, we will assign you a customer ID, Fair Credit Reporting Act (FCRA) guidelines, and a master of the FCRA Consumer Rights

If you have any questions or would like more information on our program feel free to contact us.


1. Select Level of Screening: (Click Each For a Description)

   LEVEL ONE Basic - $65.00        LEVEL TWO Basic - $77.50
   LEVEL THREE Report - $99.00        LEVEL FOUR Report - $125.00
   LEVEL FIVE Report - $185.00        LEVEL SIX Report - $255.00
   LEVEL SEVEN - $75.00 per hour        LEVEL EIGHT - $75.00 per hour

2. Enter your information:
*Name :         *Email:    
*Address:        
*City / State / Zip:    
  Account Number:                  Your reference #:    


3. Enter Applicant Information:
*Last Name:    
*First Name:      Middle Name / Initial:    
 Social Security #:      Date of Birth:     (mm/dd/yyyy)

 Current Address:         Apt #:    
 City / State / Zip:    

Past Employment Information
Company Name:      Supervisor:    
Company Address:     Company Phone:    
Position Held:     Salary:    
Start Date:     End Date :    
Company Name:     Supervisor:    
Company Address:     Company Phone:    
Position Held:     Salary:    
Start Date:     End Date :    
Company Name:     Supervisor:    
Company Address:     Company Phone:    
Position Held:     Salary:    
Start Date:     End Date :    

Personal Reference Information
Reference #1       Relationship:       Phone #:  
Reference #2       Relationship:       Phone #:  
Reference #3       Relationship:       Phone #:  

County Criminal
County:                            State:    
County #2:         State #2:    
County #3:         State #3:    

4. For report Level Two and above include this additional information:
Drivers License Number:    
State:               (Not all states available)

 Do you have a signed release for a Credit Report?    

 Yes     No
 Do you have a signed agreement with MSI for Drivers Records?      Yes     No


5. For report Level Three and above include this additional information:

Education Verification
School Name:           
School City:         School State:    
Start Date:         End Date :    
Degree:         Graduation Date :    
 Additional Information, Comments or Concerns:

6. Check that all required fields have been filled out and click the submit button: