Dear Valued TierFive Client:
This form has been created in order to allow you to complete your internal business processes by requesting copies of your records while they are in our possession being processed. To initiate the request process please complete sign and date the form below. The request will be electronically submitted. For security purposes, this form is SSL encrypted and you must be listed as an authorized document requester with our company. Also if your request is for hardcopy; as a course of business, we will scan all document copy requests prior to delivering back to you in order to ensure it is included in the conversion process.