**Please do NOT enroll your agency if your applicants will be paying for their own background checks.
Escrow Account - Complete the information on this page. A user ID and password will be emailed to the Administrator of record. Escrow Accounts are approved automatically and an email describing how to fund your Escrow accounts online by credit card, or by sending a check or money order to Gemalto Cogent, will be sent along with your user ID and password.
Billing Account- Billing account applications are not automatically approved. To qualify for a billing account, an agency must process a minimum of 100 transactions (applicants) per month. If approved for a billing account, Gemalto Cogent will send the Agency an invoice at the end of each month. If an Agency is approved for a billing account and it does not meet the 100 billable transaction minimum, or if agencies do not pay their invoice within 30 days, the billing account will be suspended. If the billing account is suspended, agencies will automatically be switched to an escrow account.
Select your agency pay type:
Escrow Account
Billing Account
Agency Information  
Agency Name:    *
Agency Address:    *
Agency City:    *
Agency State:    *
Agency Zip:    *
Agency Phone:    *
Agency Fax:    *
Agency Email:    *
Agency TAX/EIN Number:    *
Contact Person:    *
Title:    *
Billing Address (check if same as above)   
Agency that is funding the account:    *
Authorized Person:    *
Billing Address:    *
Billing City:    *
Billing State:    *
Billing Zip:    *
Billing Phone:    *
Billing Fax:    *
Billing Email:    *
Authorize Date (MM/DD/YYYY):    *
Administrator Information  
Administrator Name:    *
Administrator Title:    *
Administrator Department:    *
Administrator Address 1:    *
Administrator Address 2:    *
Administrator Phone:    *
Administrator Fax:   
Administrator Email:    *
Verification Information  
Check if same as above:   
Agency Head Contact:    *
Agency Head Title:    *
Agency Head Department:    *
Agency Head Phone:    *
Agency Head Fax:   
Agency Head Email:    *

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