FBA Premier Asset Locators - Page 1
Phone:561.866.2145- Fax:561-995-9678 Date:____/____/_____Your Reference if any:______
Your Name:______Company Name:______
Address: ______City:______State:______Zip Code: ______
Phone:______Fax:______Email:______
Search Subject Info: Please fill in all information except where noted as optional for the search:
Debtor’s Full Name(individual or company):______
Company CEO: ______Date of Birth: ______SSN/FEIN: ______
(CEO Name & SSN Required for Investment Acct. Search on Companies)
Address:______City:______State:______Zip:______
Optional Information: Telephone, cell or pager #:______
Check off as many as apply:
For Judgments $20,000 to $100,000 StatewideBankSearch (Research Fee $10) $289.00 – less than 15 days
For Judgments $20,000 to $100,000 RUSH Statewide BankSearch (Research Fee $12) $325 – 3 to 5 days
For Judgments $100,000+Statewide BankSearch (Research Fee $10) $389 – less than 15 days
For Judgments $100,000+ RUSH Statewide Bank Search (Research Fee $12) $425 – 1 to 2 day
For Judgments $20,000 to $100,000 Nationwide Bank Search (Research Fee $22) $440 – less than 15 days
For Judgments $20,000 to $100,000 RUSH Nationwide BankSearch (Research Fee $27) $440 – 3 to 5 days
For Judgments $100,000+ Nationwide BankSearch (Research Fee $22) $540– less than 15 days
For Judgments $100,000+ RUSH Nationwide Bank Search (Research Fee $27) $615 –3 to 5 days
ExcludedBanks Up to 3 Banks Per Debtor •Exclusion of known Bank charge $35 each. A maximum of $105.00. This fee is only assessed if returned as a RESEARCH. Banks to exclude ______; ______; ______.
FBA Premier Asset Locators - Page 2
Phone: 561.866.2145 - Fax: 561-995-9678
Your Name:______Company Name: ______
Debtor’s Full Name (individual or company):______
Check off as many as apply:
For Judgments $20,000 to $100,000 InvestmentRelated Account Search (Research Fee $40) Price: $595 - less than 15 days
For Judgments $20,000 to $100,000 InvestmentRelatedAccount Search (Research Fee $50) Price: $670 – 3 to 5 days
For Judgments $100,000+ Investment Related Account Search (Research Fee $40) Price: $625 - less than 15 days
For Judgments $100,000+ Investment Related Account Search (Research Fee $50) Price: $700 – 3 to 5 days
Social Security Number Search (SSN) $20 No Find No Fee
Federal Employer Identification Number (FEIN) $60 No Find No Fee
I AUTHORIZE Premier Asset Locators to conduct research on my behalf under the current Find Bank Accounts Premier Search Price List. I AGREE that a facsimile of this agreement will have the same force,effect and legal standing as the original. I ACKNOWLEDGE that I have read and agree to all the terms and conditions on the Find Bank Accounts website.I ACKNOWLEDGE that I have read and understand all the disclosures and disclaimers located on the Find Bank Accounts website. I AUTHORIZE Premier Asset Locators to charge my credit card file.
I REALIZE that omissions or errors, though rare, can occur and I will not hold Premier Asset Locators liable nor am I entitled to any damages, punitive or otherwise. In case of an error changing the status of an order from a Hit to a Research, I am entitled but limited to a refund or credit to my account in the amount of the search provided. Any disputed search results must be presented to Seize Assets within 30 days of my original receipt of research report.
Client Signature:______
Credit Card must accompany a Submitted Search Request unless already on file.
Name on credit card: ______Credit card billing address: ______
Credit card billing city: ______Credit card billing state:______billing zip: ______
Credit card type: Select One: Visa, MasterCard, AmEx, Discover Credit card number: ______
Credit card expiration date (month/year): ______CV2 Code:______
Orders may be submitted by faxing this form. Phone orders are not accepted. Orders received after 3 p.m. EST may not be processed until the following business day.