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APPLICATION

This form collects your information so that ABC Verify, a division of Fair Screen can communicate with you and provide assistance.

Background Screening is highly regulated, and approved clients must sign an application & agreement before accessing the services. This form collects your information so that ABC Verify, a division of Fair Screen can communicate with you, provide assistance, and help ensure compliance. Please check our Privacy Policy to see how we protect and manage your submitted data. We may contact you for more information during this process, and if you have any questions or need help, please call (888) 606-0007 or email solutions@fairscreen.com.

Company Legal Name(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Please select the Address Type that best corresponds with your physical address.

Dedicated Commercial Building

Multi-Tenant Commercial Building

Residential - Single Family

Residential - Apt-Condo-HighRise

Residential – Mobile Home Trailer

Retail – Shopping – Strip Mall

House Converted Strictly for Business

Other

Enter Other Details

Is your physical address the same as your mailing address?(Required)

Yes

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Main Company Phone(Required)

Website / URL(Required)

How many employees do you have?(Required)

Years in Business(Required)

Other DBA Names

List all that apply

Are You Wholly Owned By A Parent Company(Required)

Yes

Parent Company (Legal Name & Address)(Required)

Structure of Organization(Required)

State Where Organized(Required)

Is Business License Required?(Required)

Yes

Business License #(Required)

Issuer / Agency(Required)

Federal Tax ID Number

PERMISSIBLE PURPOSE

The Fair Credit Reporting Act requires that you identify the permissible purpose your company will have for ordering consumer reports. Please select all that apply.

---(Required)

Employment Screening. (15 U.S.C § 1681b (a)(3)(B))

Tenant Screening. (15 U.S.C § 1681, Section 604(a)(3)(F))

PRIMARY MANAGEMENT CONTACT

Who will be the primary management / executive level contact at your firm?

Primary Management Contact Name(Required)

First Last

Title(Required)

Phone(Required)

Email(Required)

Would you like to add a second user in the ordering platform?

Yes

User #2(Required)

First Last

User #2 Title(Required)

User #2 Phone(Required)

User #2 Email(Required)

Would you like to add a third user?(Required)

Yes

User #3(Required)

First Last

User #3 Title(Required)

User #3 Phone(Required)

User #3 Email(Required)

Would you like to add a fourth user?(Required)

Yes

User #4(Required)

First Last

User #4 Title(Required)

User #4 Phone(Required)

User #4 Email(Required)

Are you signing up for Contractor Connection background checks?(Required)

Yes

Which Contractor Connection package will you require?(Required)

The most common is the “Standard” bundle, however, some contractors have been told they need to do additional elements because they are in network for State Farm, Citizens, or Liberty Mutual. Those particular insurers have a few additional items needed.

AGREEMENT

By checking the box and entering my name below, this represents my electronic signature dated as of when I click on the [Submit] button. My signature attests that the information entered on the application above is complete & accurate, that I am authorized to enter into this agreement, and:

I AGREE to the Terms & Conditions
I ACKNOWLEDGE RECEIPT of the FCRA Summary of Rights
I ACKNOWLEDGE RECEIPT of the Notice to Users of Consumer Reports

(Required)

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AGREEMENT

By checking the box and entering my name below, this represents my electronic signature dated as of when I click on the [Submit] button. My signature attests that the information entered on the application above is complete &amp; accurate, that I am authorized to enter into this agreement, and:

<ul style="padding-bottom: 25px;list-style-type: none">
<li>&#10004; &nbsp; I AGREE to the <a style="text-decoration: underline !important" href="https://fairscreen.com/wp-content/uploads/Fair-Screen-Terms-Conditions-Oct-2025.pdf" target="_blank" rel="nofollow">Terms &amp; Conditions</a></li>
<li>&#10004; &nbsp; I ACKNOWLEDGE RECEIPT of the <a style="text-decoration: underline !important" href="https://files.consumerfinance.gov/f/201504_cfpb_summary_your-rights-under-fcra.pdf" target="_blank" rel="nofollow">FCRA Summary of Rights</a></li>
<li>&#10004; &nbsp; I ACKNOWLEDGE RECEIPT of the <a style="text-decoration: underline !important" href="https://fairscreen.com/wp-content/uploads/Revised-Notice-to-Users-11-29-12.pdf" target="_blank" rel="nofollow">Notice to Users of Consumer Reports</a></li>
</ul>

Agreement Selection(Required)

I agree to the Terms & Conditions (October 2025), and acknowledge receipt of the FCRA Summary of Rights and Notice to Users of Consumer Reports

Enter Typed Signature(Required)

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Date Submitted

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IP Address

APPLICATION

PERMISSIBLE PURPOSE

PRIMARY MANAGEMENT CONTACT

AGREEMENT

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