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2. Please complete the form below to submit your request for fingerprinting.

   Allow up to 2 business days to receive a response.

4. Payment

   Exact amount is payable at appointment by either CASH or CHECK. Credit cards are NOT accepted.

6. Contact Information
8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Home Phone Number*
20. Cell Phone Number
22. Email Address*
24. Fingerprint Information
26. Reason for Fingerprints*
28. Do you reside in the City of Farmington?*

    1. Yes
    2. No
29. Is this for a Farmington business?

    If you are not a resident of Farmington, but it is for a Farmington business the fee will be waived.

    1. Yes
    2. No
31. Farmington Business

    Please enter the name of the Farmington business.

33. $50 fee for non-residents *

    If you do not reside in the City of Farmington and it is not for a Farmington business the cost is $50. Exact amount is payable at appointment by either cash or check. By clicking Yes, you are acknowledging and agreeing to this fee.

    1. Yes
35. Preferred Date/Time 1*
    Preferred Date/Time 1 Start Date

    Preferred Date/Time 1 Start Time

    —

    Preferred Date/Time 1 End Date

    Preferred Date/Time 1 End Time
36. Preferred Date/Time 2*
    Preferred Date/Time 2 Start Date

    Preferred Date/Time 2 Start Time

    —

    Preferred Date/Time 2 End Date

    Preferred Date/Time 2 End Time
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field