AIP Solutions  

Main Line 602-297-9200
Fax Line 866-867-1084
Toll Free 866-460-7898
333 E. Osborn Ave.,
Suite #370
Phoenix, Arizona 85012

 WEB PRESCREENING FORM

Your Company Info     * required information 

Client #

* Company Name:
 * Your Name:
 

Sales #

Address: City:
State:

Zip:

* Phone:   Fax:

Date:

* Your Email Address:  
   
Applicant's Information
Applicant's Company Name:  
Address: City:
State:

Zip:

Phone: Fax:
Driver's License: State Issued:
Bank Name: Phone:
Routing Number:

Account Number:

Check Number:

Contact Name:

RESULTS
AIP Database Pos Neg  National Database Pos Neg

Disclaimer:
This information deemed reliable but not guaranteed. AIP Solutions is not recommending that your company extend credit to this applicant ... we are simply providing you additional information to make your decision.

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