Member Registration Information
Legal Company Name:
Address:
City / State / Zip Code:
Main Telephone:
Web Address:
Nature of Business:
Number of Employees:
Specific purpose for which Consumer Reports will be used:
Classification (Corporation/Non-Profit/Partnership/Sole Proprietorship):
If incorporated, please indicate the state of incorporation:
Billing Information:
Billing Address:
Billing City/State/Zip:
Primary Billing Contact: / Secondary Billing Contact:
Title: / Title:
Telephone: / Telephone:
Email: / Email:
Fax: / Fax:
Invoices are emailed from . Please white-list this domain to prevent delayed invoices.
Please check the following box if you would like to setup Automated Clearing House (ACH) payment method. A member of the CSI Client Services team will contact you with further instructions after account activation.
o Automated Clearing House (ACH)
Additional Account Information:
How many years has your company been in business?
When does your fiscal year end?
Federal tax identification number(s):
Name of bank:
Bank contact information:
Please include the following information ONLY if your company is classified as a Sole Proprietorship or Partnership:
Name(s):
Home Address:
City / State / Zip Code:
Social Security Number(s):
Account Management
Background Check Report Request Method: (Please check only one.)
o Online o Email (Encryption Required) o Secure Fax o Applicant Management Center(AMC)*
*Activation and annual re-licensing fees may apply
Background Check Report Delivery Method:
Reports will be delivered via our secure online portal. An email will notify the authorized contact(s) when reports are posted.
o Please check here if you do not have internet access and need alternative delivery methods.
Authorized Contact: (This contact will have all administrative level rights at the website.)
Primary Contact Name:
Title:
Email:
Telephone:
Confidential Fax:
Additional Authorized Contacts: Please list any other authorized contacts for your account:
Name: / Name:
o Check here to allow this contact to request background reports / o Check here to allow this contact to request background reports
o Check here to allow access to completed background reports / o Check here to allow access to completed background reports
o Check here to allow access to administrative/management reports / o Check here to allow access to administrative/management reports
Title: / Title:
Email: / Email:
Telephone: / Telephone:
Confidential Fax: / Confidential Fax:
Please list any additional contacts separately and return with this document.
Additional Information:
How many background checks do you anticipate in the next twelve months? / Q1______Q2______Q3______Q4______
CSI may occasionally need to contact your applicant(s) for additional information during our investigation. If you do not want your applicant(s) to be contacted, please select “No.” / o No, please do not contact my applicant directly.
CSI will not contact your HR Department to verify previous employment of a previous employee.
o Please check here if you would like CSI to contact you to verify employment of a re-hire.
FCRA Administration enrollment?
To learn more about this process please visit: http://www.creativeservices.com/resource-center/FCRA / o Yes FCRA Administration will incur additional fees.
o No
Client Signature:
Authorized Signature: Title:
Printed Name: Date:
Creative Services, Inc. Proprietary & Confidential 1 REV 03/15/2017