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Client Application and Information Form
(Step 1 of 5) ABOUT YOUR COMPANY:
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Company Name and DBA (if applicable):
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Street Address
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City
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State/Province/Region
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Country
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Zip Code
*
Phone Number
*
Web Address
0/255 characters
Address Type (Choose one):
*
Commercial
Residential
Number of employees:
*
Estimated volume of reports to be requested (annually):
*
1-100
101-500
501-1000
1000-5000
5000+
Business Type (choose one):
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Sole Proprietorship
State or federal government department
Partnership
Other governmental organization (describe)
Corporation
501(c) organization
LLC 501(c)(3) organization
Other (describe)
State or Country of incorporation/organization:
Year business started:
Other:
Please describe the nature of your business or industry:
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Consumer Reports will be requested for (select all that apply):
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Employment Purposes
Screening volunteers
Other consumer-authorized screening (describe):
Other:
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