EXHIBIT 10.1.4
xxx.xxxxx.xxx xxx.xxx.xxx
Consumer Report User Agreement
YOUR AVERT CUSTOMER NUMBER IS: _____________________________
__Avert should assign one Avert customer number to correspond with the unique
Company Code/Region Code of the ADP client.
__ Avert should assign multiple Avert customer numbers to correspond with the
multiple Company Codes/Region Codes associated with this ADP client. Multiple
User Agreements are attached for each Avert customer number.
__This client requires a unique set up design for billing, delivery, or multiple
Avert customer numbers, etc. Avert, Inc. should contact the ADP client before
activating the account.
Business Name (User) ___________________________________________________________
Address ________________________________________________________________________
Street City State Zip Code
Phone # _____________________ Fax # ________________________E-mail Address _____
Main Contact Name (s) __________________________________________________________
First Last Title
Billing Contact Name (if different from main contact)
________________________________________________________________________________
Phone # _____________________ Fax # ________________________E-mail Address _____
Please describe your company's business. _______________________________________
Standard Industry Code (SIC Code) __________________ How long has your company
been in business? ____________Years Identify one principal (or owner) of your
business or symbol if company is publicly traded.
----------------------- ---------------------- -------------------- ------------
Name Title Phone Symbol
Select password _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (up to 15 characters) Do you have
an Internet connection? __Yes __
_____ [a] Total # of CURRENT Employees ADPSafehire Price
_____ [b] Forecast Annual # of NEW Hires __ - 24 employees $30.00/month
_____ [c] Forecast Annual # of REPLACEMENT Hires __ - 74 employees $60.00/month
_____ Total Turnover Rate Percentage (b+c)/a __ - 99 employees $90.00/month
Monthly Subscription Fee Amount $__________
One Time Set Up Fee $ 150.00
Transaction Date: Will be between the 1st and 5th business day of each month.
Bank Name _______________________________ Account Name _________________________
Bank Address ___________________________________________________________________
Street City State Zip
Bank Phone ____________________________ Bank Contact Name ______________________
Bank Transit /ABA # _______________ Account Number _____________________________
User certifies that the "Terms for Consumer Report User Agreement" have been
read and agrees to the terms as written.
X_______________________________________________________________________________
User Authorized Signature Title Date
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Avert, Inc. Authorized Signature Title Date
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ADP (EBS) District Manager Date
ADP Company Code: ___ ___ ___ ADP Region Code: ___ ___ ___
ADP Sales Office Code: ___ ___ ___ ___ DM Code: ___ ___
[ ] Client [ ] Prospect [ ] Standalone [ ] Upgrade Platform: __AP __EZPay
DM Name: ___________________________________________ DM Phone ( ____ )__________
NOTES: (for ADP use only)
EBS EMPUA99.04
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Terms for Consumer Report User Agreement
This agreement by and between Avert, Inc. and the company named on the Consumer
Report User Agreement (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. Maintain a file of all applicant release authorizations and make such file
available for review by ADP or Avert.
10. 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.
11. Assume responsibility for the final verification of the applicant' s
identity.
12. 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.
13. 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.
14. Order the Subscription Product offered through the Avert/ADP partnership for
new and potential employees only.
15. Recognize that for the Subscription Fee indicated on the reverse of this
agreement, Avert will provide an unlimited number of Subscription Product orders
to the User for new and potential employees only.
16. Recognize that the User may order any reports, services and forms in
addition to the Subscription Product. Those fee-based Avert reports, services,
and forms will be billed to the User in addition to the Subscription Fee on a
per-transaction basis.
17. Recognize that Avert may adjust the User' s Subscription Fee, with 30 days
written notice, based on acknowledged receipt of change in employee headcount.
18. Provide credit information on User as may be requested by Avert, Inc. during
the course of this agreement.
19. Recognize that payment of the set up fee and prorated first month of
Subscription Fee will be processed upon completion of account set up. Any future
Subscription Fee and any additional fee-based Avert reports, services and forms
will be billed at the beginning of each month.
20. If you are dissatisfied for any reason, notify Avert in writing within 30
days of the date you signed this agreement and your account will be closed and
your set up fee (less charges for Subscription Fee and fee-based reports,
services or forms) will be refunded. Terms for Consumer Report User Agreement
This agreement by and between Avert, Inc. and the company named on the Consumer
Report User Agreement (User) and/or its designated agent(s) consists of the
following understandings and conditions:
21. Authorize and request Avert, Inc. to effect payment of any amounts owed by
User to Avert Inc., as amounts become due by authorizing debit entries to User'
s account at BANK. User hereby authorizes and requests BANK to accept any debit
entries initiated by Avert, Inc., and to debit the same to my account without
liability for the correctness of the entries. This authorization shall remain in
effect unless and until revoked in writing by an authorized representative of
User to BANK and Avert, Inc. as per the terms of this agreement.
22. Recognize that User acknowledges that if sufficient funds are not available
by the date required pursuant to the foregoing provisions of the Agreement, (1)
User will immediately become solely responsible for all amounts owed, and all
related penalties and interest due then and thereafter, (2) and all Avert, Inc.
services may, at Avert, Inc.' s option, be immediately suspended, (3) neither
Bank nor Avert, Inc. will have any further obligation to User or any third party
with respect to any such charges and (4) Avert, Inc. may take such action as it
deems appropriate to collect Avert, Inc.' s fees.
23. Recognize that if any change is made by Avert, Inc. in the date of the
billing cycle on or after which such entries are to be debited to such account,
Avert, Inc. shall, within not less than seven (7) calendar days before the first
entry to be affected by such change is to be debited to such account, send to
User written notification of the new date on or after which such entries are to
be debited to such account. The provision will not apply if the User has
authorized the initiation of a single entry to his account or if the User has
agreed that entries representing indebtedness to his account may be debited at
any time after the indebtedness is incurred.
24. Recognize that User may by written notice to BANK and Avert, Inc. stop
payment of any entry initiated or to be initiated by Avert, Inc. to User' s
account pursuant to this agreement but such notice must be received by BANK in
such time and in such manner as to afford BANK and Avert, Inc. fourteen (14)
business days to act on it.
25. Recognize that if an entry is erroneously initiated by Avert, Inc. to User'
s account, User shall have the right to have the amount of such entry credited
to such account by BANK if within fifteen (15) calendar days following the date
on which BANK sent or made available to User a statement of account or
notification pertaining to such entry. User shall send or deliver to BANK and
Avert, Inc. a written notice identifying such entry, stating that such entry was
in error and requesting BANK and Avert, Inc. to credit the amount thereof to
such account.
26. 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 reopen the account.
27. Acknowledge that a facsimile of this agreement is as valid as an original.
28. 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.
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