Mohave Member Registration - Request for Information and Secure Access

Mohave Member Account Registration

SecurTest Background Screening - Contract Number: 12P-SCT-0125

Welcome Mohave Members!

This form will help us create your Mohave Background Screening Program and account with SecurTest. To receive the required password for the protected documents at http://www.securtest.com/mohave/, please complete this form, call (800) 445-800, or email us mohave@securtest.com.

Within one business day of receiving your registration information, the Mohave approved agreement and purchase order, we will send your personal login username and password to the SecurTest Website. You will also receive easy-to-follow instructions on how to login, request reports, view reports and more. We are a client-focused company which means you can count on real-time customer support every step of the way.

Please call (800) 445-8001 or email mohave@securtest.com if you have any questions!

Institution Name:*

Primary Contact Name:*

Title:*

E-mail:*

Phone Number:*

Area CodePhone Number

Fax Number:

Area CodePhone Number

The Primary Contact listed above will have secure access to receive Management Reports, would they also need access to Order and View Background Reports?*

Yes, they would need secure access to receive Management Reports and to Order and View Background ReportsNo, they would only need secure access to receive Management Reports

Is there an additional authorized user who would require secure access to Order and/or View Background Reports?*

YesNo

Name of the User:

E-mail of the User:

Phone Number of the User:

Does the additional authorized user above need access to Order Reports, View Reports, or both?

Order ReportsView ReportsOrder and View Reports

* To request additional authorized login users/accounts, please contact SecurTest, Inc. at info@securtest.com or call us at (800) 445-8001.

Approximate number of employees:

Approximate number of employees hired per month:

Approximate number of volunteers or visitors needing a background check per month:

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Is your company's billing address the same as its mailing address?*

YesNo

Billing Address (if different from Mailing Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

In addition to a comprehensive User Guide designed specifically for Mohave accounts, you may also reach out to a member of our dedicated team to answer any questions regarding our user-friendly website. This one-on-one training is provided at no additional charge and ensures you can take full advantage of our services.