EXHIBIT 10.1.2
Please read and complete this agreement and fax to
Avert. If you are dissatisfied for any reason,
notify Avert in writing within 30 days of the date
you signed this agreement. Your account will be
closed and your $50.00 set-up fee (less charges
for products and services ordered) will be
refunded.
Avert Inc.
000 Xxxxxxxxx Xxxxxx
Xxxx Xxxxxxx, XX 00000
000 000 0000
000 000 0000 FAX
Consumer Report User Agreement
YOUR CUSTOMER NUMBER IS
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Business Name (User)____________________________________________________________
Address ________________________________________________________________________
Street City State Zip
Code
Main Contact Name ______________________________________________________________
First Last Title
Phone #__________________ Fax # ____________________ Email______________________
Second Contact Name (if applicable) ____________________________________________
First Last Title
Phone #__________________ Fax # ____________________ E-mail ____________________
Billing Contact Name (if different from main contact) __________________________
Phone #__________________ Fax # ____________________ E-mail ____________________
1. Please describe your company' s business.___________________________________
________________________________________________________________________________
2. List approximate number of employees._______________________________________
3. How long has your company been in business?_________________________________
4. Is your company in a: ( ) Commercial ( ) Industrial ( ) Residential
( ) Other (please explain) Building? _______________________________________
________________________________________________________________________________
5. Identify two principles (or owners) of your business, or if your company
stock is traded on a recognized stock exchange,please provide the symbol and
exchange.
-------------------------- -------------------------------------- ------------
Name Title Phone
-------------------------- -------------------------------------- ------------
Name Title Phone
-------------------------- -----------------------------------
Symbol Exchange
User certifies that the "Terms for Consumer Report User Agreement" have been
read and agrees to the terms as written.
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User Authorized Signature Title Date
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Avert, Inc. Authorized Signature Title Date
6. Select One Account Option: (Check appropriate box)
__Basic Account __AVERTadvantage for $10/month __AVERTadvantage Online
for $20/month
7. If you intend to use reports containing information obtained from credit
bureaus, (i.e., Name Link, Instant Address Link, CreditLink, etc.) please
provide a copy of ONE of the following items listed below: (Check appropriate
box)
__Sales Tax License __Business License __Articles of Incorporation
8. Select One Billing Option: (Check appropriate box)
__Bill $50.00 Set-up Fee to Credit Card (Net 30 days billing for all other
charges)
__Direct Debit (Addendum required)
__Bill Any Charges from Avert to Credit Card on an Ongoing Basis
__Net 30 Days Billing Option
9. If paying set-up fee and/or other charges by credit card, please complete the
following: (Visa, Mastercard and American Express accepted)
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Card Type Credit Card Number Expiration Date Cardholder Name
Terms for Consumer Report User Agreement
This agreement by and between Avert, Inc. and the company named on the Consumer
Report User Agreement Form (User) and/or its designated agent(s) consists of the
following understandings and conditions:
USER CERTIFIES AND AGREES TO:
1. Use the services of and the reports received from Avert in strict compliance
with all provisions 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.
2. Review the Notice to Users of Consumer Reports: Obligations of Users under
the FCRA at xxx.xxxxx.xxx/xxxx and perform legal obligations as set forth in
said Notice.
3. Use the information provided by Avert for the User's 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.
4. Make a clear and conspicuous disclosure to the applicant or employee, in
writing and in a separate document, that a consumer report may be obtained for
employment purposes.
5. 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.
6. Obtain the proper written authorization from the applicant or employee for
any consumer report prior to requesting any report.
7. 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 Avert, Inc.
8. Ensure that reports will be requested only by User's designated
representatives and forbid employees from obtaining reports on themselves,
associates or any other person except in the exercise of their official duties.
9. Recognize that information is obtained and managed by fallible sources, and
that for the fee charged,Avert does not guarantee or insure the accuracy or the
depth of information provided.
10. Assume responsibility for the final verification of the applicant's
identity.
11. Base employment decisions or any actions on the User's lawful policies and
procedures and recognize that Avert employees are not allowed to render any
legal opinions regarding information contained in a consumer report.
12. Recognize that once Avert, Inc. has delivered your customer number to the
main contact person listed on this agreement, that the security and
dissemination of this unique customer number is the responsibility of the person
signing this agreement. Avert will neither release information nor take orders
for services unless the customer number is provided.
13. Pay for services based on a statement system similar to ones used by
telephone companies.Terms are NET 30 days. Accounts in arrears will assume a
finance charge of 2% per month or the highest lawful rate, whichever is less. If
an account goes to collection, User agrees to pay all expenses, including
reasonable legal fees.
14. Provide credit information on User as may be requested by Avert, Inc. during
the course of this agreement.
15. Be aware that, if an account remains inactive for twelve consecutive months,
it may be closed and a new User Agreement may be required to re-open the
account.
16. Acknowledge that a facsimile of this agreement is as valid as an original.
17. Recognize that in order to remain in compliance with laws and regulations
governing consumer reporting agencies Avert may make modifications to this
agreement from time to time. These modifications may be mailed to the User and
the User's use of Avert's services after the date specified in the communication
will be construed as your agreement and implied consent to these modifications.
AVERT AGREES TO:
1. Comply with all applicable laws in the preparation and transmission of
reports as defined in 15 USC-1681 et seq, regulated by the Federal Trade
Commission.
2. Follow reasonable quality assurance procedures to assure maximum possible
accuracy of information.
3. Re-verify at no cost any disputed report when either the User or the subject
makes a request in accordance with applicable law. Avert's response shall be
made in writing and delivered in a timely manner.
4. 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 receive a copy of
the report ordered by the User when a lawful request is made to Avert.
5. Provide all information to the consumer as required by the Fair
Credit Reporting Act.
6. Maintain confidentiality of its data acquisition and
verification methodology.
7. Avert may, at its sole discretion, terminate
service to any User.
