In order to provide services for your business, Applicant-Screening.com needs to learn a few things about you. See the Notice below for complete details.

Please fill out the form below and submit it to us via email, or download this form in PDF or Microsoft Word format, print out, and fax to us.

Service Application - Microsoft Word 97 (ServiceApp.doc)
Service Application - Adobe Acrobat, Portable Document File (SeviceApp.PDF)

Business Information

No. of Units:

   County:

Business Address:

City:

Billing Address:
(if other than above)

City:

What type of property is your place of business?
  (check one)  Commercial   Residential

E-Mail Address:

Details

Name of Person responsible for accounts payable:

 County Sales Tax:

Explain in detail the type of business you are engaged in:

Explain in detail the purpose for which your company will use credit information:

Below, please list the names of ALL persons in your organization, including yourself, that you authorize to have access to confidential credit information and to make a purchase for which your company will be billed.  (Use FULL Names)

Certification

1. I agree to notify Applicant-Screening.Com, Inc. of the termination of an employee or their access privileges. Applicant-Screening.Com, Inc. will make changes to employee roster only during regular business hours.

2.  I accept that it is the responsibility of my authorized employees to furnish Applicant-Screening.Com, Inc. with complete and accurate data such as Applicant Name, Addresses including zip code, Social Security Number, etc… In the event that Applicant-Screening.Com, Inc. is furnished with inaccurate or incomplete data, Applicant-Screening.Com, Inc. assumes no responsibility for inaccurate or incomplete reports returned to the authorized employee.

3.  I accept that Applicant-Screening.Com, Inc. reserves the right to charge 10% per month interest on outstanding balances over 60 days. I also agree to pay collection costs and attorneys fees in the event of default of this agreement.

4.  I certify that when requesting credit information from Applicant-Screening.Com, Inc., I have a signed authorization from each applicant and will retain authorization on record for a period of not less than two (2) years. At all times, I will be able to produce authorization signatures when requested by Applicant-Screening.Com, Inc. or by Subpoena.

5.  I certify that credit reports will be used solely for the legal "permissible purpose" specified and approved above. If credit history is necessary for any other purpose, Applicant-Screening.Com, Inc. will be notified prior to the request.

6.  I agree to hold all Credit information as confidential and not to disclose Credit information in whole or in part to the subject of the report (applicant) or to any third party not involved in the related, specific business transaction. I agree not to alter the content, sell or give away Credit Reports obtained from Applicant-Screening.Com, Inc. and comply with Public Law 91-508, The Fair Credit Reporting Act.

7.  I understand that violation of the Fair Credit Reporting Act may constitute a punishable Federal offense and that other Local, State and Federal laws may govern my access and use of credit information. Applicant-Screening.Com, Inc. may terminate my access to Credit information without notice.

8.  Applicant-Screening.Com, Inc. agrees to use it’s best efforts to gather information from sources deemed reliable and to report information accurately. I agree that under no circumstances will Applicant-Screening.Com, Inc. be liable for errors or omissions or for any consequential damages however arising including damages arising from the use or misuse of credit information. I agree to indemnify Applicant-Screening.Com, Inc. and hold Applicant-Screening.Com, Inc. harmless from any claims that may arise from the information released. Applicant-Screening.Com, Inc. will furnish credit reports solely based on that indemnification. Applicant-Screening.Com, Inc. does not recommend or make any credit granting decisions.

9.  This agreement shall continue in force without any fixed date of termination. This agreement shall not be altered, varied or enlarged upon by any verbal promises, statements or representations not expressed herein. This agreement shall be interpreted in accordance with the laws of the State of Florida.

This application is not complete unless it is accompanied by the following supporting documentation: A Business License, A State Registered License, a Real Estate License or a Business Tax Statement, or for rental property owners, a copy of the title, deed or property tax documents for each property.