Important:  All information must be completed in its entirety.

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 01 02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012

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 3^rd 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

00 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2008 2009
Authorized Signature Date

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