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First Check Service Agreement
General Company Information
*Company NameLegal Name
List Other Company Names or DBA`s
*How Long in Business?
Type of Ownership
Main Company Contact
E-Mail:Valid e-mail is required
Web Site Address
*Phone Info
Fax
*Physical Address
*City
*State
Zip
Principal of the Company
Principal Name
Title or Posistion
*Last 4 Numbers in SSN
*Year of Birth
*Residential Address
*City
*State
Zip
Business Information
*Type of Business
Estimated # of Reports MonthlyEstimate Your Monthly Usage
Do You Need Access To Credit Reports?
Yes No 
*Permissible Purpose
*Are you a TAHC&H Member?
Yes No 
Member NumberTAHC&H Member Number
Payment Information
Credit Card Will Be Charged Monthly - Monthly Invoice Provided
*Name On Credit CardEnter Exact Name On Card
*Credit Card NumberCard Number Only - No Dashes
*Expiration Date01/08 format
Security Code3 digit security code
Card Brand:
*Billing Address On CardEx: 123 Main St
*City
*State
*Zip
Net 15 Terms Available To Qualified Companies - Monthly Invoice Provided
Billing Contact Name
*Billing Address
*City
*State
Zip
*Phone Info
Fax
Terms and Conditions - Service Agreement
*Enter Your Name
Enter Your Last Name
By entering my first & last name above, I stipulate that I have read the service agreement above, and agree to all of it`s terms and conditions. I agree to abide by all applicable laws and agree to the pre- and post-notification requirements and applicant authorization prescribed by the FCRA section 1681b and section 1681m.
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