Customer Application
    
  

Customer Application

 Important:  All information must be completed in its entirety. Please print clearly and legibly to help ensure accurate and timely processing.

General Company Information

 Company Name
Years in Business yrs mos

 Type of Ownership (indicate one) Partnership Sole Owner Non-Profit Corporation

 Have you previously applied to purchase reports from ABI? Yes No
If yes, when?
Under what business name?

Physical Street Address (No P.O. Box numbers please):

 Address 1:

Address 2:

City State Zip
How long? yrs mos

 Phone -- Ext.# Fax -- 

 E-mail Confirm E-mail

 Previous Address

 Physical Street Address (No P.O. Box numbers please):

 Address 1:

Address 2:

City State Zip
How long? yrs mos

 Do you Own Lease the building in which you are located (please check one)

 Type of business

Do you have an Investigation License? Yes No
If yes, please provide a copy with this application.

 Approximately how many Pre-Employment Profiles will you be ordering monthly?

Please provide a copy of your Yellow Pages advertisement and other advertising material (i.e. Trade Magazine).

 Principal of the Company

 I understand that the information provided below may be used to obtain a consumer credit report, and my credit-worthiness may be considered when making a decision to grant membership.

 Principal name (corporation or individual)

 Phone -- 

 Social Security Number or Tax ID number

Affiliated or Parent Company Information

 Do you use credit profiles or Pre-Employment Profiles for more than one business or branch of your organization? Yes No

 If yes, please provide information below:

 Affiliated or Parent Company

Contact Name

Title  

 Address 1:

Address 2:

City  State  Zip 
How long?  yrs  mos Phone -- Ext.#  Fax --  E-mail  Confirm E-mail  Federal ID Number  Permissible Purpose Information (Application will not be processed unless this information is provided)

 Describe the specific purpose for which Experian credit information will be used. Please check one or more:

 Employment Background Screening
Tenant Screening
Extension of Credit
Not running Credit Reports

 Bank Reference(Please provide the name of the bank which maintains your business checking account)

 Bank Name:

Address 1:

Address 2:

 City  State  Zip 

 Phone -- Ext.#  Fax -- 

 Business Checking Account Number(s)

Business        Visa  MasterCard  American Express
Card #        Expiration date

Would you like all of your cases billed to your credit card? Yes No

 I have read and understand the "FCRA Requirements" and "Access Security Requirements" notice and will take all reasonable measures to enforce them within my facility. I certify that I will use the Experian/Trans Union  credit report for no other purpose than what is stated in the Permissible Purpose section on this application. I will not sell the report to any 3rd Party directly or indirectly. All replications of this Application shall be deemed an original.

 I certify that I have read the above statements and all information provided is accurate and hereby authorize the bank reference to release information to Alpha Background Investigations, LLC. I authorize Alpha Background Investigations, LLC to charge my Credit Card for services rendered if not paid within 30 days or other agreed to payment term and condition.


Electronic Signature(Name of individual completing form)
Company Name
Type or Print Name and Title of Owner or Officer


Authorized Signature Date

 By submitting the following page, I agree that I am the person who completed the form above.

  
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