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Business Information

Requested Relationship to Equifax

Company Name

Federal Tax ID #

Does your Company have any other names or DBAs?

Yes No

Company Street Address

Zip Code

City

State

This is also my company's: Billing Address Mailing Address

Company Phone

Company Website URL

Email

Does your business operate from a residence? Yes No

Billing Information

Would you like electronic invoices? Yes No (Subject to $18. monthly fee)

Contact First and Last Name

Title

Billing Contact Phone

Billing Address

Zip Code

City

State

Mailing Information

Name (Attention to:)

Title

Mailing Contact Phone

Fax #

Mailing Address

Zip Code

City

State

Onsite Property Observation

Equifax may conduct an onsite property observation of our company which must be conducted prior to your account being established. The following information must be completed to facilitate the property observation. Equifax uses a virtual application to initiate the onsite process.

Contact name

Telephone Number

Email Address

Contact Title

Alternative Phone Number

Alternate Contact Name

Permissible Purpose Declaration

Select the specific purpose for which credit information will be used

In connection with credit transaction(s) involving a consumer extension of credit including mortgage Underwrtiting of insurance

Elegibility for government benefit Potential investor or servicer, or current insurer of existing credit obligation

Business Structure

Your Company's Business Structure

Industry

Nature of Business

Company is a Bank, credit union, or FINRA regulated brokerage firm Yes No

Industry type requires licensing from the State or other government entity: Yes No

Business License Issuer

Department

License #

Where will Equifax Data be Stored?

Operations or Agents Outside US

Company has operations or agents outside US or its Territories Yes No

Ownership Outside the US

Do the either of following statements apply to your company?

1. There are business entities that have a greater than 20% ownership or interest in our company that are not based or organized in the US.

2. There are individuals that have an ownership interest in our company that are not citizens or residents of the US

Yes No

Shared Office Space

Company shares office space with another company: Yes No

IT HAS BEEN DETERMINED THAT YOUR COMPANY FALLS INTO A CATEGORY THAT EQUIFAX DESCRIBES AS “MIXED-USE”, WHICH MEANS THAT BECAUSE OF THE BUSINESS THAT YOU DO, IT IS POSSIBLE THAT YOU COULD USE THE CONSUMER REPORTS YOU OBTAIN FROM OUR DATABASE FOR VARIOUS PURPOSES, SOME OF WHICH ARE NOT SANCTIONED BY THE FAIR CREDIT REPORTING ACT (“FCRA”). SOME OF THE EQUIFAX SERVICES BEING SOUGHT BY YOUR COMPANY ARE PROVIDED FROM A CONSUMER REPORTING DATABASE, AND AS SUCH, REPORTS CAN ONLY BE OBTAINED AND USED BY YOUR COMPANY FOR THE PERMISSIBLE PURPOSES SET OUT IN SECTION 604 OF THE FCRA. THIS WILL BE FURTHER SPELLED OUT IN YOUR CONTRACT WITH US. IN ORDER TO OBTAIN ACCESS TO THE FCRA REGULATED SERVICES FROM EQUIFAX, YOU HAVE AGREED TO CERTIFY THAT ANY SERVICES REGULATED BY THE FCRA THAT YOU OBTAIN FROM EQUIFAX WILL BE USED EXCLUSIVELY FOR THE PERMISSIBLE PURPOSE AS DESCRIBED WITHIN THIS APPLICATION AND WILL NOT BE SHARED WITH OR USED BY ANY OTHER FUNCTION PERFORMED BY YOUR COMPANY. YOU HAVE FURTHER AGREED TO ACCEPT AND COOPERATE WITH ANY AND ALL INQUIRIES/REVIEWS/AUDITS REQUESTED BY EQUIFAX. THE BELOW SIGNATURE OF AN OFFICER OF THE NAMED COMPANY WITHIN THIS APPLICATION WILL SERVE AS SUCH CERTIFICATION AND AGREEMENT AND WILL BE EFFECTIVE ON THE DATE OF SIGNATURE AS AN AMENDMENT TO THE SPECIFIC AGREEMENT. PLEASE CERTIFY BELOW.

PLEASE CERTIFY BELOW.AUTHORIZED SIGNATORY AS AN AUTHORIZED AGENT OF THE APPLICANT COMPANY I CERTIFY THAT ANY FCRA REGULATED DATA OBTAINED FROM EQUIFAX WILL BE OBTAINED AND USED EXCLUSIVELY FOR THE APPLICANT COMPANY FOR THE PERMISSIBLE PURPOSE(S) AS DESCRIBED WITHIN THIS APPLICATION AND SUCH DATA WILL NOT BE SHARED WITH OR USED IN ANY OTHER MANNER BY THE APPLICANT COMPANY. I FURTHER AGREE, ON BEHALF OF THE APPLICANT COMPANY, THAT EQUIFAX MAY REVIEW OR OTHERWISE AUDIT MY COMPLIANCE WITH THIS CERTIFICATION, AND THE APPLICANT COMPANY WILL FULLY COOPERATE WITH ANY SUCH REVIEWS AND/OR AUDITS.

I Certify

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