Application for non-member service contract. The undersigned (hereinafter referred to as the Applicant) petitions the Credit Bureau named below (hereinafter referred to as the Credit Bureau) for the use of its services upon the basis outlined below, and if accepted by said Credit Bureau as a non-member user of service, agrees that the following shall constitute the service contract between the Applicant and the Credit Bureau. THE APPLICANT AGREES: That Applicant will comply with all the provisions of Public Law 91-508. That information will be requested only for the Applicant's exclusive use, and the Applicant certifies that inquiries will be made only when the Applicant intends to use the information for a permissible purpose, namely: (A) In connection with a credit transaction involving the consumer on whom the information is to be furnished and involving the extension of credit to, or review or collection of an account of, the consumer; or (B) For employment purposes; and Applicant agrees (1) to give advance notice to the consumer that a report may be requested for employment purposes, and (2) to identify to the Credit Bureau each request for a report to be so used at the time such report is requested; or (C) In connection with the underwriting of insurance involving the consumer; or (D) In connection with a business transaction involving the consumer; and the Applicant agrees to identify to the Credit Bureau each request at the time such report is ordered, and to certify the legitimate business need for such report. Reports on employees will be requested only by the Applicant's designated representatives. Employees will be forbidden to attempt to obtain reports on themselves, associates, or any other person except in the exercise of their official duties. (Public Law 91-508 provides that any person who knowingly and willfully obtains information on a consumer from a consumer reporting agency under false pretenses shall be fined not more than $5,000 or imprisoned not more than one year, or both.) To furnish the Credit Bureau with written and oral information giving the following data: (A). The names and addresses of customers whose accounts have been restrained or closed by Applicant (and the reasons therefore); or placed for
collection; or repossessed; or charged off as a loss. (B). Information on active and inactive accounts and any pertinent other information to make the Credit Bureau's files more complete, immediately when requested by the Credit Bureau. (C). Such pertinent information on present or former employees as may be requested by the Credit Bureau. All information received from the Credit Bureau, whether written, printed or oral, is for the exclusive use of Applicant, and in case the disclosure of such information leads to any claims or litigation, to hold the Credit Bureau harmless from any liability, or damages resulting therefrom. The Credit Bureau shall not be liable in any manner whatsoever for any loss or injury to Applicant resulting from the obtaining or furnishing of such information and shall not be deemed to have guaranteed the accuracy of such information, such information being based, however, upon reports obtained from sources considered by the Credit Bureau to be reliable. Not to ask the Credit Bureau to disclose the sources from whom or by which the information was obtained. To pay upon receipt of billing for the report or reports which the Applicant hereby requests the Credit Bureau to furnish, and for any and all reports or information subsequently requested, according to the regular Non-Member rate schedule of charges now or subsequently established by the Credit Bureau, plus the charges for any special telephone or telegraph services or other special services rendered. THE CREDIT BUREAU AGREES To maintain files on individuals, firms or corporations, recording information furnished by its members or subscribers or obtained from other available sources. To furnish all available pertinent information on individuals, firms or corporations, including but not limited to: identifying information, credit history, employment and public record information in file; such information being furnished at the special request of Applicant, as evidenced by the signature of this application. IT IS MUTUALLY AGREED that this service contract, if accepted by the Credit Bureau, shall remain in force and effect for one year and thereafter, from year to year, on the same basis as set forth herein until written notice of cancellation shall be given by either party at least 10 days prior to cancellation. It is further agreed, however, that if the Applicant is delinquent in the payment of charges, or is guilty of violating the terms of this contract, the Credit Bureau may, at its
election, discontinue providing service to the Applicant and cancel this contract immediately by written notice to the Applicant. The Applicant hereby tenders the sum of _________ Dollars, ($_____), as an initial fee, for which the Applicant is to receive _________ provided this application is accepted by the Credit Bureau. Dated at _________, this day _________[date] APPLICANT: _________ By: _________ Name (Type—Print) SIGNATURE _________
Title _________(OWNER, CORPORATE OFFICER, PARTNER, OR MANAGER) Address _________ Zip Code _________
Type of Business _________ Telephone _________ Bank References _________ Trade References _________ Persons to be authorized to request Credit Reports _________ ACCEPTED for the Credit Bureau named below _________ By: _________ Title: _________
Date: _________
Non-Member Identification Number Assigned: _________