Account Update Request

BIM OHIO NATIONAL WEBCHECK FINGERPRINT SYSTEM ACCOUNT UPDATE REQUEST

If you currently have or are in the process of obtaining an Ohio National Webcheck fingerprint system from BIM and you wish to make a change to your account record, please completely fill out and submit this form.

This form will submit to our Support team who will then make the requested changes on your account.

Please summarize what is changing.
Agency Information
Agency Name*

Enter the name of your agency, company organization, entity, etc.
Agency Address*
Address Line 1 Address Line 2 City State ZIP Code

There is where we will ship your fingerprint system.
County*
BCI Agency Code*

Your 6-digit agency code provided by Ohio BCI. If you do not yet have an agency code from Ohio BCI, please input all zeros: 000000. You must apply for and provide your Ohio BCI agency code to BIM before we can deliver your fingerprint system.
Contact Information
Primary Contact Name*
First Last
The primary buyer or organizer for the fingerprint system within your agency.
Primary Contact Phone #*
Primary Contact Phone Ext (optional)
Primary Contact Email Address*
LSA/Technical Contact Name*
First Last
Live Scan Administrator or Technical contact; who we may contact for Support.
LSA/Technical Contact Phone #*
LSA/Technical Contact Phone Ext (optional)
LSA/Technical Contact Email Address*
Billing Contact Name*
First Last
Person responsible for handling A/R or A/P for fingerprint system.
Billing Contact Phone #*
Billing Contact Phone Ext (optional)
Billing Contact Email Address*
Billing Address (if different than agency address)
Address Line 1 Address Line 2 City State ZIP Code

It is only necessary to complete the billing address fields IF your billing address differs from your agency address.
Are you tax exempt?*
If you answer YES for your agency, you must submit your Ohio Sales Tax Exemption Certificate to accounting@bioinfomgt.com.

Account Update Request

BIM OHIO NATIONAL WEBCHECK FINGERPRINT SYSTEM ACCOUNT UPDATE REQUEST

Agency Information

Contact Information