Membership Application Membership Application 2024 Company InformationCompany Name:Company DBA(s):Nature of Company’s Business:Intent for Use of Consumer Reports:Classification of Company’s Business: Non-Profit City Country Federal For-Profit Company EIN:URL/Website:Office Address:City:State:Zip Code:Office Phone:Fax:Email:Number of Leagues:Anticipated Background reports per year: _Director Information (Required to have on file by the Fair Credit Reporting Act (FCRA), 15 U.S.C. § 1681 Name:Social Security Number:Home Address:City:State:Zip Code:Accounts Payable Contact Information Name:Office Phone:Fax:Email:Account Pricing Details Monthly Fee: $0 Startup Fee: $195 (WAIVED FOR NON-PROFIT) Price per report: $14.95 Invoice and reconciliation report will be emailed at the end of each month totaling all reports run during the month and the total amount due. All invoices will be due upon receipt. I hereby declare that the information provided herein is accurate, valid and a full disclosure of requested information. I am fully authorized to represent the organization listed above, to act on behalf of it, and to legally bind it in all matters related to this application. Signature of Authorized End UserDate
