Membership Application

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	Company Contact Information				New Client Application

	Company Name:
	Years in Business: Years Months
	Type of Ownership: Partnership Sole Owner Nonprofit Corporation LLC
	Do you have any other company names or DBA? Yes No If Yes, please list:

	Physical Street Address (no P.O. box numbers, please)
	Address City State Zip
	How Long at this address? Years Months
	Own or Lease Building? Own Lease - *Is this a residential address? Yes No

	Company Telephone Number ( ) Fax Number ( )
	Company Website URL Contact Email Address *Required

	Previous address required if you have not been at the above address for 2 years or more
	Previous Address: City: State: Zip:
	Length of time at this address Years Months

	Principal of Company
	Principal Name: Principal Title: Year of Birth: SSN:
	Residential Street Address: City: State: Zip:
	Phone Number:( )

	General Company Information

	Type of Business: Number of reports pulled each month:
	Do you already have a credit reporting LOS package? Yes No - If yes, Who?
	Does your company qualify for sales tax exemptions? Yes No
	Do you have any branch offices? Yes No

	Affiliated or Parent Company Name? (if any)
	Contact Name: Contact Title:
	Address City State Zip Phone ( )

	Specific reason for which Experian, TransUnion, and Equifax product information will be used