Po Box 35563
Tulsa, OK 74153
(800) 256-8898
Fill out each tab below, clicking [Next >>] when completed, then click [Submit Application].

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Who may we thank for your referral/How did you hear about us?

We apply for membership in ACCUFAX and hereby appoint ACCUFAX as member’s agent for purposes of inquiry as to Credit History, Employment, Factual Pre-Employment reports, Volunteer reports, Driving records, Criminal and other public record history information. We agree to abide by the applicable Federal (91-508), State Fair Credit Reporting and Equal Credit Opportunity Acts, and all other laws pertinent to any inquiry or information requested through ACCUFAX, our agent, for our use.

One Time Set-Up Fee and Permissible Purposes:
Employment Screening/Volunteer Screening (Type Code 35)   $50.00 We agree to pay charges due on receipt of statements, at time of receipt; to pay 1.5% monthly interest on charges 30 days or more past due; to pay reasonable attorney fees for the enforcement of the terms of this agreement. If the member is delinquent in payment of charges, or is violating the terms of this agreement, ACCUFAX may, at its election, discontinue providing service and cancel this agreement immediately on written notice to the member.

I certify that we are the end user and that we will not resell the information in whole or in part to any third party. By typing your member name below exactly as it appears above, you are electronically signing this document.

E-Signature (type name):   Date: Wednesday, October 18, 2017 via: 54.80.10.56

MEMBER SERVICE AGREEMENT rev 06/04
Subscriber employs ACCUFAX herein for a beginning period of twelve months and this agreement automatically extends for additional twelve month periods thereafter. This agreement may be terminated at any time on thirty days written notice.

The monthly charges are payable on receipt of invoice or statement. A minimum delinquency charge of five dollars will be added for outstanding balances of less than three hundred dollars. Accounts over three hundred dollars will have a delinquency charge of the maximum percentage allowed by law added to the balance of any account balance thirty days past due.

The information provided to certain subscribers are based on a facsimile of the records of criminal histories, driving records or other such public record information requested by subscriber. No warranty, express or implied, exists that the person who is the subject of the inquiry is in fact the same person that may be found in the facsimile record of the court clerk’s office or files. Positive identification must be made by the subscriber. Further, ACCUFAX does not indemnify subscriber from any loss resulting from inaccuracies from public record or third party sources.

ACCUFAX warrants a complete and correct listing of cases or other related similarly named cases as they appear in the public records in the geographical area in which ACCUFAX has compiled data.

Subscriber agrees ACCUFAX may use subscriber name in it’s promotion or advertising material.

ACCUFAX shall not be held responsible or liable for any delays in or failure or suspension of service caused by mechanical or power failures, strikes, labor difficulties, fire inability to operate or obtain service for its equipment, acts of God or other causes beyond the control of ACCUFAX or ACCUFAX suppliers.

Subscriber agrees in the event of the breach of security at the subscriber’s location(s) or by a subscriber’s employee, or ex-employee to hold ACCUFAX harmless and indemnify them from any and all loss.

Subscriber certifies it has legitimate business purpose and need in connection with a business transaction involving any information provided by ACCUFAX and subscriber certifies that the information provided by ACCUFAX may only be used for permissible purpose as described in public law 91-508, Federal Fair Credit Reporting Act. Further, subscriber nor its employees will obtain any personal credit histories or other information provided by ACCUFAX, on themselves, through ACCUFAX, nor will any information be reported in violation of any other provision of 91-508 permissible purposes, including Section 605 “obsolete information”, or any other federal or state law. Violation of this agreement may result in automatic termination and litigation.

This agreement may be assigned by subscriber only with the prior express written consent of ACCUFAX. Subscriber shall not permit any person, other than its officers, agents or employees to use subscriber’s access number(s), or software or terminals used to access ACCUFAX systems at any location not authorized by ACCUFAX.

In the event subscriber violates the terms of this agreement, subscriber agrees to pay all costs for steps taken by ACCUFAX, whether by lawsuit or otherwise, to defend, preserve, or enforce the rights under this agreement. Subscriber and ACCUFAX further agree that this agreement shall be governed by, construed and enforced under the internal laws of the State of Oklahoma. In addition, all rights and duties of Subscriber and ACCUFAX, arising from services performed or agreed to be performed by ACCUFAX, shall be determined under the internal laws of the State of Oklahoma. The exclusive venue for any litigation involving (I) this agreement or enforcement thereof, or (II) any claims between Subscriber and ACCUFAX arising from services performed or agreed to perform by ACCUFAX, shall be the District Court of Tulsa County, Oklahoma or the United States District Court for the Northern District of Oklahoma, and Subscriber expressly consents to the jurisdiction of those courts for the purposes of such litigation.

Subscriber, by providing ACCUFAX with information regarding tenants, potential employees or volunteers warrants the information collected and distributed to ACCUFAX, if any, is accurate and factual and Subscriber shall hold ACCUFAX harmless from any liability arising from the use of such information. This agreement is governed by the laws of the State of Oklahoma and shall inure to and be binding upon the successors and assigns of ACCUFAX and the heirs, executors and assigns of the subscriber.

Subscriber herewith nominates, appoints and employs ACCUFAX as the subscriber’s agent for the purpose of inquiry as to the rental history, credit history, credit rating, employment history, factual pre-employment information, verification of employment and other such public record information as shall be requested. All information collected and gathered shall be deemed to be on the part of the Subscriber and such information shall become the sole property of ACCUFAX once collected.

ACCUFAX or ACCUFAX do not warrant the accuracy or timeliness of wanted fugitive reports. Subscriber warrants that ACCUFAX and ACCUFAX will be held harmless of any liability or damage arising from using wanted fugitive reports or violation or misuse of any information by Subscriber.

Click Here to Accept Terms of this Agreement.   
Date: Wednesday, October 18, 2017 via: 54.80.10.56


Certification of Permissible Purpose
Client named below certifies it will obtain consumer credit information through Accufax only for the following specific purposes and for no other purpose. (Check all that apply):

Credit information is not needed (continue to the next tab if you check this).

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. Client will not use these reports for employment purposes.

For employment purposes. Client will use Credit reports only for employment purposes, and will not access any other credit information for employment purposes. Client will not order or use a Credit reports to determine eligibility for credit or insurance or in connection with the collection of a debt. Client certifies that it will make the disclosures and meet the conditions required by the Fair Credit Reporting Act (“FCRA”), §1681b, as amended, to the subject of each Credit reports it accesses, and that information from the report will not be used in violation of any applicable Federal or State equal employment opportunity law or regulation. If Client takes any adverse action based on any information from a credit reports, Client will verify that information through another source.

In connection with the underwriting of insurance involving the consumer. Client will not access credit reports in connection with any insurance purpose other than underwriting. Client will not access credit reports on any consumer after the consumer has filed a claim for proceeds of any insurance policy.

In connection with a determination of the consumer’s eligibility for a license or other benefit granted by a governmental instrumentality required by law to consider an applicant’s financial responsibility or status. Client must be a governmental instrumentality or acting as an agent for a governmental instrumentality.

In connection with a valuation of, or an assessment of the credit or prepayment risks associated with, an existing credit obligation. Client must be a potential investor in, potential servicer of, or current insurer of an existing credit obligation.

In connection with a business transaction involving the consumer. Accufax will not accept this Certification unless an explanation of the business transaction is provided here or attached.

In connection with the establishment of an individual’s capacity to make child support payments or determining the appropriate level of such payments. Client must be the head of a state or local child support enforcement agency or authorized by the head of such an agency. Client certifies that it will make the disclosures and meet the conditions required by the Fair Credit Reporting Act (“FCRA”), §1681b, as amended, to the subject of each report it accesses, and that information from the report will not be used in connection with any other civil, administrative, or criminal proceeding, or for any other purpose.

Client is a government agency and will access identifying information, limited to name, address, former addresses, places of employment, or former places of employment.

  
MEMBER SERVICE AGREEMENT

ADDENDUM TO ACCUFAX MEMBER SERVICE AGREEMENT
-AGREEMENT OF COMPLIANCE-

In compliance with the Federal Fair Credit Reporting Act as amended by the Consumer Credit Reporting Reform Act of 1996, 15 U.S.C. Section 1681 et. Seq. (The Act)
(“End User”) hereby certifies to ACCUFAX DIV., SOUTHVEST Inc. (A Consumer Reporting Agency) that it will comply with the following provisions:

  1. End User will ensure that prior to requesting or making request for a consumer Report or a consumer report for employment purposes that:
    1. a clear and conspicuous disclosure has been made in writing to the consumer (applicant) at any time before the report is requested or procured, in a document that consists solely of the disclosure, that a consumer report may be obtained for employment purposes; and
    2. the consumer has authorized in writing the procurement of the report by the End User.

  2. In using a consumer report or consumer report for employment purposes, before taking any adverse action used in whole or in part on the report, the End User shall provide to the consumer (applicant) TO WHOM THE REPORT RELATES;
    1. a copy of the report; and
    2. a description in writing of the rights of the consumer under the Act.

The information from the consumer report will not be used in violation of any applicable federal or state equal employment opportunity law or regulation, or any other applicable law.

End user hereby acknowledges receipt of the Summary of Consumer Rights, and agrees to indemnify and save harmless ACCUFAX Div., Southvest Inc., its affiliated companies, their officers, employees, and agents from any and all liability and responsibility arising from End User’s failure to comply with the Fair Credit Reporting Act. rev 01/07

I have read all 3 pages and understand the above conditions of this agreement. By typing your member name below exactly as it appears on the 'Member Information' tab, you are electronically signing this document.

E-Signature (type name):   Date: Wednesday, October 18, 2017 via: 54.80.10.56


Check if you do not wish to have access to your credit data through Experian and opt out of filling out this information:
Membership Application

Company Name:         Years in Business: yrs         mos.
Type of Ownership (indicate one):        
Do you have any other company name(s) or dba?                 If Yes, please list:
Have you previously applied or have been an Experian Member?                 If Yes, when?
Under what business name?    Previous member number (if known):

Physical Street Address (no P.O. box numbers, please):
City:            State:
select
  ZIP:        How Long? yrs     mos.
Phone:          Fax:    Is this a residential address?      
Previous Address:
City:            State:
select
  ZIP:        How Long? yrs     mos.
Do you own or lease the building in which you are located? (please check one)        

I understand that the information provided below will be used to obtain a consumer credit report, and my creditworthiness may be considered when making a decision to grant membership

Principal First Name: Principal Last Name:
Title or Position: Phone:
Social Security Number: Year of Birth:
Residential Street Address:
City: State:
select
  ZIP:

* Do you have any branch offices located in the state of California?        
Affiliated / Parent Company Name:
Contact Name: Title:
Address: Phone:
City: State:
select
  ZIP:

Type of Business:    Do you need a Purchase Order?                 PO#
Do you have an Investigation License?                If Yes, please provide a copy with this application.
Estimated # of Credit Reports you will access monthly:
How will you access the Credit Reports?        
Do you already have a credit reporting software package?              If Yes, what is the name?
Does your company qualify for sales tax exemptions?                     If Yes, please provide proof.

Please describe the specific purpose for which Experian product information will be used. (What will you do with the information obtained?)
This section MUST be completed


Contact Name: Phone:
Address:
City: State:
select
  ZIP:

Bank Name: Phone:
Address:
City: State:
select
  ZIP:
Business Checking Account Number(s):
The following applies to consumer credit products (i.e. Consumer Credit Reports, Business Owners Profile, and Small Business Intelliscore):

I have read and understand the "FCRA Requirements"notice and Experian's "Access Security Requirements" and will take all reasonable measures to enforce them within my facility. I certify that I will use the Experian product information 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 will not sell the report to any consumer directly or indirectly. 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.

Important Tax Notice
You may disregard the following Tax Notice, if you are located in one of the following areas: Arkansas, Connecticut, Hawaii, Maryland, New Mexico, New York, Oklahoma, Pennsylvania, South Carolina, South Dakota, West Virginia, Washington D.C. or Chicago, IL. The State of Texas charges sales tax for credit reports on Texas consumers. Experian will include the taxes in our billing of any reports ordered with a Texas current address. You may be exempt from these taxes for one of the following reasons: 1.) Your company does not do business in the State of Texas. 2.) Your credit report purchases are for resale. 3.) Your company is exempt from all state taxes. If you are not exempt, you may qualify to pay the taxes directly to the State, rather than to Experian. Please review the exemption certificate that came with this application. If there is a reason for you to be exempt, complete the Tax Notice and return it to us.

I certify that I have read the above statements and all information provided is accurate and hereby authorize the Bank Reference to Release information to Experian. By typing your company name & member name below exactly as it appears on the 'Member Information' tab, you are electronically signing this document.

Company Name E-Signature (type name):
Date: Wednesday, October 18, 2017 via: 54.80.10.56


ADDENDUM TO ACCUFAX DIV., SOUTHVEST INC.
BUSINESS INFORMATION SERVICES AGREEMENT
FOR INTERNET DELIVERY
     This Addendum to ACCUFAX Div., Southvest Inc. Business Information Services Agreement for Internet Delivery (the "Addendum") is made as of Wednesday, October 18, 2017 via: 54.80.10.56, by and between ACCUFAX Div., Southvest Inc.("Distributor" or "Reseller"), Experian Information Solutions, Inc. ("Experian") and ("Subscriber").

     WHEREAS, Distributor (or Reseller) and Subscriber have entered into a Business Information Services Agreement, dated Wednesday, October 18, 2017 via: 54.80.10.56 (the "Agreement") whereby Distributor (or Reseller) provides certain on-line business credit reporting services ("Services") to Subscriber; and

     WHEREAS, Subscriber has requested access to certain services offered by Experian through an Internet connection ("Internet Credit Delivery Services" or "ICDS"), and Experian desires to allow such access based on Subscriber's and Distributor's (or Reseller's) agreement to the terms and conditions set forth herein.

     NOW, THEREFORE, in consideration of the foregoing and other good and valuable consideration, Experian, Distributor (or Reseller) and Subscriber agree as follows:

  1. Subscriber shall obtain Internet access to ICDS only through the individual Subscriber employees who are specifically approved by Experian upon the written request of Subscriber and on the terms and conditions contained in this Addendum (each an "Authorized Employee"). Subscriber shall request Internet access in writing in a form approved by Experian from time to time. Authorized Employees will be assigned unique access identification numbers ("User ID") and passwords. Experian's approval of requests for Internet access may be granted or withheld in its sole discretion. Experian may add to or change its requirements for granting Internet access to ICDS at any time [including, without limitation, the imposition of fees relating to Internet Access upon reasonable notice to Distributor (or Reseller)], and reserves the right to change passwords and to revoke any authorizations previously granted. Distributor (or Reseller) shall notify Experian, in writing, whether or not Subscriber has signed a certification agreeing to comply with the federal Fair Credit Reporting Act relating to its use of Experian's Business Owner Profile ("BOP") and Small Business Intelliscore ("SBI") services. Subscriber may not access BOP or SBI services through an Internet connection unless such certification has been executed.
  2. Only Authorized Employees shall utilize Internet access, and only through the User ID and password assigned to such employee by Experian. Subscriber shall request User ID's and passwords only for those employees of Subscriber who have a legitimate need to access ICDS in performing his or her duties for Subscriber. Prior to requesting User ID's for Authorized Employees, Subscriber shall provide adequate training regarding the requirements to this Addendum and applicable laws. Subscriber will ensure that each Authorized Employee (i) is familiar with the requirements specified herein, and agrees to comply with such requirements, (ii) agrees not to disclose the User ID and password assigned to the Authorized Employee to any other person, and (iii) agrees not to order business credit reports or other data from Experian's site except in performance of Employee's official duties for Subscriber.
  3. Subscriber acknowledges and agrees that it is responsible for all activities of Subscriber’s employees in utilizing Internet access and for assuring the facilities for receipt of information provided to it through the Internet are secure and in compliance with the Agreement. Subscriber shall not retransmit or otherwise make available to any person ICDS (including any of the information therein) on or through the Internet or other generally accessible network or delivery method.
  4. Subscriber agrees to notify Experian in writing immediately if it wishes to delete any employee as an Authorized Employee or if any Authorized Employee is terminated or otherwise loses his or her status as an Authorized Employee.
  5. Subscriber acknowledges and agrees that this Addendum is in addition to the requirements of Distributor's (or Reseller's) membership application process, including Access Security Requirements (except where expressly modified by this Addendum) which are applicable to Distributor's (or Reseller's) provision of BOP reports and SBI services. Subscriber will abide by any additional or further security procedures specified by Experian or Distributor (or Reseller) from time to time.
  6. Subscriber shall use its best efforts to ensure the confidentiality of all User ID's and passwords issued by Experian to Subscriber's employees. Subscriber shall indemnify Experian against any damage or disruption to Experian systems or business caused by Subscriber’s employees, subcontractors, subcontractor employees or its clients whether as a result of their access to such systems or compromise of password confidentiality or otherwise.
  7. Subscriber understands that its use of Experian networking and computing resources may be monitored and audited by Experian, without further notice.
  8. Experian may from time to time audit the security mechanisms Subscriber maintains to safeguard access to Experian information, systems and electronic communications. Audits may include examination of systems security and associated administrative practices.
  9. If Experian or Distributor (or Reseller) believes that Subscriber has breached a material obligation contained in this Addendum, Experian or Distributor (or Reseller) may terminate this Addendum immediately by providing the other parties notice of termination.
  10. Experian shall have no obligation or liability for or on account of any mechanical or other breakdown, malfunction or defect in the Internet connection accessed by Subscriber. EXPERIAN MAKES NO WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, THE WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, IN CONNECTION WITH THIS ADDENDUM. NOTWITHSTANDING ANY OTHER PROVISION OF THIS AGREEMENT, UNDER NO CIRCUMSTANCES WILL EXPERIAN HAVE ANY OBLIGATION OR LIABILITY TO SUBSCRIBER FOR ANY CLAIM, INJURY OR DAMAGE RELATING TO, ARISING OUT OF, OR RESULTING FROM SUBSCRIBER'S INTERNET ACCESS TO THE SERVICES.
  11. NOTWITHSTANDING ANY OTHER PROVISION IN THIS AGREEMENT, UNDER NO CIRCUMSTANCES SHALL A PARTY BE LIABLE TO THE OTHER FOR ANY INCIDENTAL, CONSEQUENTIAL, SPECIAL OR INDIRECT DAMAGES (INCLUDING, WITHOUT LIMITATION, ANY INDIRECT DAMAGES ARISING FROM THE LOSS OF BUSINESS, DATA, PROFITS OR GOODWILL WHICH ARE NOT DIRECT DAMAGES) INCURRED OR SUFFERED BY THAT PARTY BY REASON OF THE OTHER PARTY’S PERFORMANCE OR NONPERFORMANCE UNDER THIS ADDENDUM, OR FOR ANY OTHER REASON, EVEN IF APPRISED OF THE LIKELIHOOD OF SUCH DAMAGES.
  12. Except as expressly amended by this Addendum, the Agreement remains in full force and effect. The terms of this Addendum shall prevail in the event of any inconsistency between this Addendum and the Agreement.


     IN WITNESS WHEREOF, Subscriber, Distributor (or Reseller) and Experian have each caused this Addendum to be executed by their respective duly authorized representatives as of the date first above written. By typing your member name below exactly as it appears on the 'Member Information' tab, you are electronically signing this document.

Experian Information Solutions, Inc. by and
through its Information Solutions Division
E-Signature (type name):
Date: Wednesday, October 18, 2017 via: 54.80.10.56