Client Application and Service Agreement

The information provided is sensitive in nature. To maintain compliance with the Fair Credit Reporting Act, the Driver Privacy Protection Act, and various other state laws and regulations, we must verify the legitimacy of all accounts. We reserve the right to limit access to our services based upon verification of your business.

This form must be completed by an officer of the company or other individual authorized to enter into a legal contract on behalf of your company.

If you have any questions, please call (718) 540-4946

If you have any questions, please call
(718) 540-4946

Company Name

Company Phone

Company Fax

Company Address

Street Address

Address Line 2

City

State

ZIP Code

Number of Employees

Please describe the nature of your business. (Maximum of 250 characters)

Federal Tax ID Number

Secretary of State Number

State of Formation

Date Formed

Business Structure

Company Website

Name of Person Completing Form

First Name

Last Name

Email of Person Completing Form

Title of Person Completing Form

Promotional Code

Useful Information

I will screen applicants / employees / contractors for my company only. I will screen applicants / employees / contractors for my company and other companies. I plan to order driving records. I plan to order drug tests / occupational health services.

Authorized Company Representative

First Name

Last Name

Note: This form must be completed by an officer of the company or other individual authorized to enter into a legal contract on behalf of your company.

Must Agree to items below.

Customer Agreement

I have read and I agree to the terms described in the Customer Agreement.*

Fair Credit Reporting Act

I agree to comply with the Fair Credit Reporting Act and all state and local laws and ordinances that govern employment background checks.

* Link to Customer Agreement