Client Application

Important: 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.

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.

If you have any questions, please call (855) 611-3443.

Company Address

Street Address *

Address Line 2

City *

State *

ZIP Code *

# of Employees *

Business Details

Nature of Business * (max 250 chars)

Federal Tax ID *

Sec. of State # *

State of Formation *

Date Formed *

Business Structure *

Promotional Code

Contact Information

First Name *

Last Name *

Email *

Title *

Authorized Company Representative

First Name *

Last Name *

Title

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.

Useful Information

Screen for my company only

Screen for my company & others

Plan to order driving records

Plan to order drug tests

Agreements (Must Agree)

Customer Agreement * — I have read and agree to the Customer Agreement

Fair Credit Reporting Act * — I agree to comply with the FCRA and all state and local laws governing employment background checks

Company Information

Company Address

Business Details

Contact Information

Authorized Company Representative

Agreements (Must Agree)