Intake Form

This form allows us to conduct a background check and pull any previous Michigan criminal convictions you may have. Our ideal customer is someone with Michigan criminal convictions that they want expunged. Please fill out the form to the best of your ability. If you don't know all the information off the top of your head, don't worry about it. Just tell us what you know, and we'll do the rest.

Please enter your details

First Name *

Middle Name *

Last Name *

Date of Birth *

Race (These are are the categories available on the State of Michigan's Criminal History Access Tool and should not *

American Indian or Native Alaskan
Asian or Pacific Islander
Black
Unknown/Other
White

Year(s) of Conviction(s), If Known

Street *

City *

State *

Email Address Where You Would Like To Receive Your Report *

Phone Number *

Gender at Time of Conviction(s) *

Male
Female
Other

County/Counties Where Convicted *

New field *

Email

support@cleanslatecheck.com

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