NCO Credit Services: Application for Service


Please read Instructions before starting your application.

Fields marked with * are required



General Company Information

Company Name: *
Physical Address: *
(no P.O. Box Numbers)
City: *
State: *
Zip: *
How Long? Years
Months*
Phone: *
(e.g.000-000-0000)
Fax:
(e.g.000-000-0000)
Is this a residential Address? *
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Do you own or lease the building in which
you are located? *
+
Is Mailing Address same as
Physical Address? *
+



Principal of the Company


Principal Name: *
Title or Position: *
Email Address: *
Residential Address: *
City: *
State: *
Zip: *
Social Security Number: *
(e.g.000-00-0000)
Residential Phone: *
(e.g.000-000-0000)
Cell Phone: *
(e.g.000-000-0000)


(I understand that by providing this information, I authorize NCO Credit Services to obtain a consumer credit report from any or all of the
national repositories and that my creditworthiness may be considered in the approval process.)



Business Information


Type of Business: *
Year Business Established: *
Type of Ownership: *
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Mortgage License No.: *
Licensed in what state(s): *
Business License No.:
Articles of Incorporation No.:
Tax ID No.:
Current Credit Reporting Vendor: *
Estimated monthly credit report volume: *
Do you use a loan origination package? *
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Does business/company have a website? *
+
Is business/company associated with
credit repair and/or credit counseling? *
+



Permissible Purpose / Appropriate Use


 All requestors of a consumer credit report must have a permissible purpose as described in section 604 of the Fair
 Credit Reporting Act (FCRA). Please review "Exhibit A" for further explanation.

 Please describe the "specific" purpose for which you will be requesting credit reports: *





Bank References


Bank Name: *
      Business Checking Account No.: *
Address: *
City: *
State: *
Zip: *
Phone: *
(e.g.000-000-0000)
Fax:
(e.g.000-000-0000)
Contact Name: *



Trade References


Company Name: *
             Account No.: *
Address: *
City: *
State: *
             Zip: *
Phone: *
(e.g.000-000-0000)
Fax:
(e.g.000-000-0000)
Contact Name: *


Company Name:  
             Account No.:  
Address:  
City:  
State:  
             Zip:  
Phone:  
(e.g.000-000-0000)
Fax:  
(e.g.000-000-0000)
Contact Name:  



Authorized Users


Please review Exhibit B "Notice to users of Access Security Requirements" and provide a list of employees authorized to access credit reports on behalf of your business/company:


Approved Employee's Full Name: *
Email Address: *
If you have additional authorized
users you would like to add now,
please enter how many:


Name of Owner or Officer responsible for completing the application: *


Title: *
Date: *
(e.g.mm/dd/yyyy)


I certify that I have read and accept all the terms and provisions of the NCO Credit Services Subscriber Agreement.I further certify that I have read and understand the associated Exhibits in particular the "notice to users of consumer reports"and the "notice to users of Access Security Requirements".I certify that I will use NCO Credit Services reports for no other purpose other than what is stated in the Permissible Purpose / Appropriate Use section on this application and for the type of business listed on this application. I understand that if my system is used improperly by company personnel, or if my access codes are made available to any unauthorized personnel due to carelessness on the part of any employee of my company, I may be held responsible for financial losses, fees or monetary charges that may be incurred and that my access privilege may be terminated. +
                                                                                                                                                                      

By selecting submit I authorize NCO Credit Services to investigate the references, statements and other data contained in this application. I certify that all information provided is accurate. All replications of this application shall be deemed an original.




(Please review your application for accuracy before you submit.)