Print this page out.  Fill it in completely and fax to the number below. 

Incomplete applications WILL NOT BE ACCEPTED.

User IDs and Passwords are available to law enforcement agencies ONLY.

(Please print CLEARLY)

Application for Access to TIBRS Online Reports

(Please print CLEARLY)

Agency Name:        _________________________________________________

ORI:                       _________________________________________________

Agency RAC:         _________________________________________________

Address:                 _________________________________________________

                              _________________________________________________

Email Address:       _________________________________________________

(Applications without an email address cannot be processed.)

Phone Number:      ________________________________ ext:  _______

Please select a password for your agency.  It MUST be 6-8 characters in length, no

embedded blanks and contain a combination of letters and numbers.  Applications

with invalid passwords WILL NOT BE ACCEPTED!

_____  _____  _____  _____  _____  _____  _____  _____

Agency Head Signature:_________________________________________

Agency Head Name (Please Print):_________________________________

Date:                ________________________________________________

You will be notified by email once your password has been accepted and your access is active.

Please return completed forms to:

Tennessee Bureau of Investigation

Crime Statistics Unit

901 R. S. Gass Blvd.

Nashville, TN  37216-2639

FAX  (615) 744-4662

FOR TBI USE ONLY

Account established _____________   _____________  _____________

                                                   date                     initials                   tested