The purpose of this request form is to acquire a letter certifying that you have had service at a particular location during a specified timeframe. This letter serves as official documentation of your tenure or activity at that place. Please enter an address and select the matching address. If the address is not shown then BCWS services are not available at that location.

Note: The letter of connect will be sent to the provided email.

(*) Indicates a required field



Applicant's Information

Applicant's Name:*

Email:*

Phone Number:*

Last 4 digits of SSN:* Date of Birth:*