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New Account Setup Form 

Company Name
Business Specialization
Business Address
City
State Zip
Telephone
Fax
EMail Address
Contact Name
Title
Type of Business
Sole Proprietor Partnership Corporation
State of City of
Company Principal(s) Not required for professional corporations and/or publicly traded corporations that have been in business for more than 5 years.
Name Title SSN
Name Title SSN
Name Title SSN
Banking Institution
Name
Branch Address
Branch City
Branch State Zip
Branch Phone
Contact Name
Account Type
Account No
Account Type
Account No
Account Type
Account No
Business Credit References
Creditor Name
Phone Account No
Creditor Name
Phone Account No
Creditor Name
Phone Account No

I certify that I am authorized to execute this Subscriber Application and Service Agreement on behalf of the company listed above. Further, I certify on behalf of such company, that the above statements are true and correct and agree of the company to the terms and conditions set forth in the Subscriber Service Agreement. My signature also authorizes the above listed references to release the company’s bank and trade credit information.

Signature (for mail or fax) _____________________________________
Print Name
Title

Please read and complete the service agreement. You may click the Submit button, fax the form to 281.419.2502 or mail it to us at the address below. Please be sure to sign the agreement before mailing or faxing it.

Selection Management
P.O. Box 130369
The Woodlands, TX 77393-0369 USA
Voice: 281.419.2500, FAX: 281.419.2502


IMPORTANT NOTICE FOR SUBSCRIBERS


The Federal Fair Credit Reporting Act permits consumer-reporting agencies to provide consumer reports only for certain purposes. Any subscriber who uses false pretenses to obtain a consumer report may be subject to criminal prosecution. It is also a law violation for us to give you a consumer report unless your purpose for obtaining it is permissible under the Act. This means that you must always tell us the true reason for requesting a consumer report. If the reason is not a permissible one under the Act, we are required by law to deny your request. Listed below are the only purposes that Section 604 of the Act permits.

  1. Pursuant to court order, of a subpoena issued by a federal grand jury.
  2. Pursuant to the written instruction of the consumer on whom the report is sought.
  3. For use in connection with a credit transaction involving the consumer. Evaluating a "Consumer Credit Application" or reviewing or collecting on a credit account are all permissible purposes for obtaining a consumer report. It is not permissible for a creditor to obtain a report on a consumer unless the consumer has applied for credit or has an existing credit relationship with the creditor. Location or litigation purposes are never permissible unless they involve collection of the consumer's credit account.
  4. For use in employment decisions involving the consumer. An employer (or its agent) may obtain a consumer report in order to evaluate the consumer for possible employment, promotion, reassignment or retention.
  5. For use in connection with a consumer’s eligibility for a license or benefit granted by governmental agency that is required to consider the applicant’s finances in the process.
  6. For use in connection with a business transaction involving the consumer. This section provides a strictly limited basis for obtaining a consumer report. To qualify, the business transaction must involve some benefit for which the consumer has applied. A consumer’s application to rent an apartment or open a checking account would qualify, as would a consumer’s request to pay for goods by check. The business transaction must not involve credit, employment, or insurance—those purposes are permissible only if they meet the standards of (3, 4, and 5).

CONSUMER REPORTS WILL BE PROVIDED ONLY FOR THESE PURPOSES!

Standard Release Forms are needed for the following reports:

  1. Credit Reports
  2. Motor Vehicle Reports in Arkansas. California requires state release form.
  3. Workers Comp in the following states: Alabama, Canada, District of Columbia, Delaware, Idaho, Massachusetts, Minnesota, Nevada, New Hampshire, North Dakota, South Carolina, South Dakota, Utah, Virginia, W. Virginia. Wyoming.
  4. Statewide Criminal Records in the following states: Idaho, Minnesota, North Dakota, and Rhode Island.
  5. Special state forms required for statewide in: Alabama, Georgia, Illinois, New Hampshire, New Mexico, and Virginia.
  © Copyright 2003, Selection Management. All rights reserved. For more information,
please contact the Selection Management webmaster. Page last updated March 4, 2005.