Hire Image Account Request Form

Review in detail and complete this agreement.

If your company does more than five searches per month you may apply for corporate billing from Hire Image on a net 30 days for its services. If your company does less than five searches per month you can have a deposit of $250.00 with Hire Image Services or pay by credit card for its services. When your account is established, we will email and/or call you with your Client account number. Hire Image will send you an executed copy of this agreement.

DELIVERY ADDRESS FOR REPORTS: One address must be the physical location of your company.

Name of Business:
Company Authorized Users:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

Contact Name(s)
First: Last: Title:
First: Last: Title:

I. Company Overview

A. Please provide a brief description of your company's business.


B. Number of employees or associates:

C. Approximately how many searches will you be placing monthly:

D. How long has your company been in business?

E. Identify two principals (or owners) of your business, or, if your company stock is traded on a recognized stock exchange give symbol and exchange.

Name:
Telephone:
Name:
Telephone:
Symbol and Exchange:

Client certifies that the "Terms for Client Report Agreement" on the bottom of this page have been read and agrees to the terms as written.

II. Client Report Agreement

Terms and Conditions

This agreement by and between Hire Image Services, Inc. and the company named below ("Client") and/or its designated agent(s) consitsts of the following understandings and conditions.

Client certifies and agrees to:

A. Use the service of and the reports received from Hire Image Services, Inc. in strict compliance with all providsions of the Fair Credit Reporting Act(FCRA), Public Law 91-508 and the Americans with Disabilities Act (ADA 1990), and all other applicable federal and state laws and regulations including federal and state equal opportunity laws and regulations.

B. Use the information provided by Hire Image Services, Inc. for the Clients exclusive use only, except to disclose said information to the subject of the report, and for employment purposes only, and only in accordance with applicable law.

C. Make clear and conspicuous disclosure to the applicant or employee, in writing and in a seperate document, that a consumer report may be obtained for employment purposes.

D. Make a clear and accurate disclosure to the applicant or employee if an investigative consumer report (reference check) will be obtained, including a statement informing the subject of the report that additional information is available if requested.

E. Obtain the proper written authorization from the applicant or employee for any consumer report prior to requesting any report.

F. Provide proper notice to the applicant or employee, a copy of the report obtained, and a Summary of Rights, as required by the FCRA, if an adverse decision regarding employment is going to be made due to information in any report obtained from Hire Image, Inc.

G. Ensure that reports will be requested only by Clients designated representatives and forbid employees from obtaining reports on themselves, associates or any other person except in the exercise of their official duties.

H. Recognize that information is obtained and managed by falible sources, Hire Image will make an effort to insure the accuracy of information provided for the fee charged.

I. Assume responsibility for the final verification of the applicant's identity.

J. Base employment decisions or any actions on the Clients lawful policies and procedures and recognize that Hire Image Services, Inc. employees are not allowed to render any legal opinions regarding information contained in a consumer report.

K. Pay for services based on a statement system. Terms are net 30 days. If account is in arrears, Hire Image will notify client approval with five days notice to cure such defiency. If client does not bring account current with five days, Hire Image may suspend services to client. If any account goes to collection, User agrees to pay all expenses, including resonable legal fees.

L. Provide Hire Image Services, Inc. during the course of this agreement may request credit information on Client.

M. If an account remains inactive for twelve consecutive months will automatically be closed.

N. Acknowledge that a facsimile of this agreement is as valid as an original.

O. Recognize that in order to remain in compliance with laws and regulations governing consumer - reporting agencies Hire Image Services, Inc. may make modifications to this agreement from time to time. These modifications may be mailed to the Clients and the Clients' use of Hire Image Services, Inc. after the date specified in the communication will be constructed as your agreement and implied consent to these modifications.

III. Hire Image Services

Agrees to the following

A. Comply with all applicable laws in the preparation and transmission of reports as defined in 15 USC - 1681 et seq. regulated by Federal Trade Commission.

B. Follow reasonable quality assurance procedures to assure maximum possible accuray of information.

C. Re-verify at no cost any disputed reports when either the Client or the subject makes a request in accordance with applicable law. Hire Image Services, Inc. response shall be made in writing and delivered in a timely manner.

D. Maintain consumer report information and transaction details for a minimum of two years. During an inquiry, the subject of the report has the right to learn the name of the User ordering information and has the right to recieve a copy o the report ordered by the Client when a lawful request is made to Hire Image Services, Inc.

E. Provide all information to the consumer as requested by the Fair Credit Reporting Act.

F. Maintain confidentiality of its data acquisition and verification methodology.

G. Hire Image Services, Inc. may, at its sole discretion terminiate service to any client providing thirty days advance notice.