Point of Contact Information Form Contact Information: (Physical location required) Agency/Company Name: Address: Street :

City:

State:

Zip:

Contact Information: Primary:

Title:

Telephone:

Email:

Secondary:

Title:

Telephone:

Email:

Other:

Title:

Telephone:

Email:

State:

Zip:

Billing Information: (if different than above) Agency/Company Name: Address: Street :

City:

Telephone:

Fax:

Email:

Primary Contact:

Title:

Email:

Secondary Contact:

Title:

Email:

Additional Notes: May we contact your applicant(s) for additional information: Yes □

No □



HR TruCheck, Inc

3525 Highway 138 SW, Stockbridge, Ga. 30281 ~ Phone (866)-773-3675 ~ Fax (866) 760-1878 ~ [email protected]



HRTC Point of Contact Form (POC) 2016.pdf

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