e-VERIFILE.COM Customer Profile

Become An e-VERIFILE.COM Customer

Access e-VERIFILE.COM's on-line reports in a few easy steps:

Fill out the Customer Profile (this page) and print it.
Print the e-VERIFILE.COM Subscriber Agreement. Please read, complete, and sign.
Print the Nationwide Criminal Database Check (NCDC) Service Agreement Addendum if you require NCDC Reports. Please read, complete, and sign.
Print the Motor Vehicle Subscriber Agreement and the supporting documents if you require MVR Reports.
Fax your completed forms to 770.859.0717.

Print a copy of the appropriate application from your browser's print menu. If you experience problems, please call Customer Support at 770.859.9899 Ext: 1.

If you prefer, applications can be mailed to:

e-VERIFILE.COM, Inc.
900 Circle 75 Parkway, Suite 620
Atlanta, GA 30339

Customer Profile
Fields in red are required

How did you hear about us?:

Business Name:

Business Address:

City/State/Zip:

Bus. Telephone:

Fax:

Year Founded:

Bus. TAX ID:

E-Mail:

Contact Name:

Title:

Telephone:

Type of Business:

Business License Number:

(Please fax a copy to 770-859-0717)

Billing Contact Name:

Billing Contact Telephone:

Billing Contact E-mail Address:

Bank Name:

Bank Telephone:

Bank Address:

City/State/Zip:

Business References: (Provide three references)

Business Name #1:

Business Telephone #1:

Contact Name #1:

Business Name #2:

Business Telephone #2:

Contact Name #2:

Business Name #3:

Business Telephone #3:

Contact Name #3:

Additional Users for the e-VERIFILE.COM System (fill out if needed)

Name:

E-mail:

Uses for e-VERIFILE.COM data --PLEASE CHECK ALL THAT APPLY--

Employment screening--any background check of an individual for hiring or retention purposes

Consumer lending and credit decision-making, including mortgage lending and credit application screening as well as decision-making regarding account limit increases/decreases or offering of more or less favorable account terms

Consumer insurance underwriting

Qualifying individuals for government licenses/benefits

Residential tenant screening

Collections of consumer accounts

Any use of data for the above purposes requires full compliance with the FCRA

The reports listed below require additional information and paperwork --PLEASE CHECK THOSE THAT APPLY TO YOU--

Motor Vehicle Reports (Motor Vehicle Subscriber Agreement)

Consumer Credit Reports (Trans Union, Experian, Equifax)

Credit Report Scoring:

None

FICO

Other

The above information will be treated as strictly confidential and used by e-VERIFILE.COM for investigative purposes only.