Cover Sheet & Sign-Up Instructions
To
From
Fax
Date
mm/dd/yyyy
Phone
Phone
Copyright © 2005
GETTING STARTED IS EASY!
1. Please complete the following User Agreement. Be sure to include each additional
Authorized User. You may either:
1. Print out the form and fi ll it in by hand or
2. If you have Adobe Acrobat Reader version 5 or later, you may fi ll out the pdf form in your
browser by clicking on the form fi elds (or by pressing TAB), then print and fax .
You may download Adobe Acrobat Reader version 5 or later at:
http://www.adobe.com/products/acrobat/readstep2.html
2. Sign page 2 and page 6 of the agreement. Signatory must have authority to bind your
organization.
3. Fax documents toll-free to (800) 355-7941 , ATTN: Account Activation
4. Upon receipt of the completed and signed User's Agreement, a Premier Account
Representative will contact you to fi nalize the set up and walk you through an easy-to-use
ordering system.
Premier Account Activation
(800) 355-7941
(800) 350-7941
Consumer Report User Agreement
To ensure your Consumer Report User Agreement is processed in a timely manner, please type or print the
following information.
Section A: Client Organization Information
Client Organization Legal Name
Legal Street Address
City / State / Zip
Phone (xxx) xxx-xxxx
Fax (xxx) xxx-xxxx
Website
Billing Street Address if different from Legal
City / State / Zip
Billing Contact
Billing Contact Title
Billing Contact Phone
(xxx) xxx-xxxx
Billing Contact Email
Number of Employees
Type of Business
# of years in Business
Anticipated # of people to be screened per year
Section B: Primary Authorized User Information
Primary Authorized User Name
Title
Contact Phone (xxx) xxx-xxxx Fax (xxx) xxx-xxxx
Email
Requested User Name/Login
Section C: Permissible Purpose for Access to Premier Consumer Reports
(check all that apply)
q
For employment purposes to include hiring, promotion, reassignment or retention and/or,
q
For a legitimate business need in connection with a business transaction initiated by a Consumer and/or,
q
For the underwriting of insurance as a result of an application from a Consumer or by a current insurer
in an assessment of the credit risks associated with an existing obligation.
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Section D: Additional Authorized User(s) Information Client may list additional Authorized
Users below. Client must provide a copy of the terms of this agreement to each Authorized User and each
User must agree to the terms set forth in this agreement.
Additional Authorized User Name
Title
Phone
(xxx) xxx-xxxx
Email
Requested User Name/Login
Additional Authorized User Name
Title
Phone
(xxx) xxx-xxxx
Email
Requested User Name/Login
Additional Authorized User Name
Title
Phone
(xxx) xxx-xxxx
Email
Requested User Name/Login
Section E: Client Authorization
I agree that a fax or photocopy of this authorization is to be considered and accepted with the same
authority as the original. Client signatory must have authority to legally bind the client.
Authorized By
(Print or Type Name)
Title
Phone
(xxx) xxx-xxxx
Email
Signature
Date
mm/dd/yyyy
Section F: Premier Employment Screening Services Authorization (Premier Use Only)
Authorized By
(Print or Type Name)
Title
Signature
Date
mm/dd/yyyy
SERVICES COVERED BY THIS AGREEMENT ARE PROVIDED IN ACCORDANCE WITH THE TERMS AND CONDITIONS
ON PAGES FOUR THROUGH SIX OF THIS AGREEMENT.
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Copyright © 2005
Business Validation
In an effort to safeguard the consumer information obtained and the integrity of our clients, a business
validation is conducted on all organizations requesting consumer report information.
If your organization is a PUBLIC CORPORATION, complete Section A only.
Section A:
Date of incorporation mm/dd/yyyy
Market traded on
Symbol
Other organization types not publicly held including sole proprietor, privately held, non-profi t, etc.,
complete Section B Only.
Section B:
1. BANK REFERENCE:
Bank Name
Phone
(xxx) xxx-xxxx
Contact Name
Account Number
2. BUSINESS REFERENCE: (Must provide two)
Business Name
Contact Name Phone
(xxx) xxx-xxxx
Business Name
Contact Name Phone
(xxx) xxx-xxxx
3. IDENTIFY AT LEAST ONE PRINCIPAL OR OWNER OF YOUR BUSINESS:
Name
Title
Name
Title
4. ATTACH A COPY OF YOUR BUSINESS LICENSE.
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Copyright © 2005
CONSUMER REPORT USER AGREEMENT STATEMENT OF
TERMS AND CONDITIONS
The Premier Company, LLC, also referred to as Premier Employment
Screening Services, collectively ("Premier") is a Consumer
Reporting Agency ("CRA") and Consumer information provided
to Clients by Premier is a Consumer Report or an Investigative
Consumer Report ("Report"). Premier derives information for
Reports in accordance with the Fair Credit Reporting Act, as
amended ("FCRA"). If Client has requested access to and been
approved for access to Premier Services ("Services") that include
receiving Reports from Premier, then in connection with requesting
and/or receiving any Reports from Premier, Client certifi es and
agrees to:
1. CONSUMER REPORT USER OBLIGATIONS
A) Review the Notice to Users of Reports: Obligations of Users under
the FCRA, at www.ftc.gov or as otherwise provided by Premier and
perform legal obligations as set forth in such notice. Premier will abide
by all of the provisions of the FCRA as they pertain to the obligations of
Premier acting as a Consumer Reporting Agency.
B) Obtain and use Reports provided by Premier only for the specifi c
permissible purpose or purposes ("Permissible Purposes") set forth in
hereunder and no other and only in accordance with applicable law. The
only Permissible Purposes are:
(i) employment purposes, including evaluating a Consumer for
employment, promotion, reassignment or retention as an employee,
where the Consumer has given written permission, (ii) a legitimate
business need in connection with a business transaction initiated by
a Consumer, (iii) for the underwriting of insurance as a result of an
application from a Consumer or by a current insurer in an assessment of
the credit risks associated with an existing obligation, (iv) as instructed
by the Consumer in writing. Client may disclose information within any
Report obtained from Premier, in accordance with applicable law; to the
Consumer who is the subject of such Report or as ordered by a court or
a federal grand jury subpoena.
C) Obtain the proper written authorization from the Consumer for each
Consumer Report and investigative Consumer Report prior to requesting
any Report.
D) Ensure that Reports will be requested only by Client's Primary
Authorized User or additional Authorized User(s) and only for the
Permissible Purposes listed above in 1(i).
E) Be responsible for the fi nal verifi cation of the Consumer's identity.
F) Be responsible for the security and dissemination of Customer
Number(s), User Name(s), Password(s) or other Account Identifi er(s)
used to access information from Premier. User will change user name
and password every 90 days from the date of the agreement.
G) Be responsible for the security and dissemination of Consumer
Reports and take appropriate measures to dispose of sensitive
information derived from Consumer Reports.
H) Receive such communications as Premier deems necessary to
ensure Client is made aware of changes in procedure or applicable law.
I) If Reports will be used for employment purposes, Client certifi es and
agrees to:
(i) make a clear and conspicuous written disclosure to the Consumer
before the Report is procured or caused to be procured, in a document
that consists solely of the disclosure, that a Consumer Report may be
obtained for employment purposes, (ii) obtain prior written authorization
from the Consumer for the procurement of the Report (which
authorization may be made on the document referred to in clause (i)),
(iii) provide to the Consumer, a summary of the Consumer's rights, as
prescribed by the Federal Trade Commission, (v) certify to Premier that
the above steps have been followed, that the information being obtained
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will not be used in violation of any federal or state equal opportunity law
or regulation, (vi) have policies and procedures in place that address the
use of Consumer Reports.
J) If an Investigative Consumer Report (a Report containing
information about a Consumer's character, general reputation, personal
characteristics or mode of living obtained through personal interviews)
will be procured from Premier, Client certifi es and agrees to:
(i) make a clear and accurate written disclosure to the Consumer that
(a) an investigative Consumer Report including information as to his
character, general reputation, personal characteristics and mode of
living, whichever are applicable, may be made, (b) includes a statement
informing the Consumer of his or her right to request additional
disclosures of the nature and scope of the investigation and the summary
of Consumer rights required by Section 609 of the FCRA., (ii) upon the
written request of a Consumer made within a reasonable period of time
after the disclosures required above, make a complete disclosure of the
nature and scope of the investigation requested. This disclosure must
be made in a written statement that is mailed, or otherwise delivered, to
the Consumer no later than fi ve days after the date on which the request
was received from the Consumer or the Report was fi rst requested,
whichever is the later.
(K) If Client takes any type of adverse action that is based at least in part
on information contained in a Consumer Report obtained from Premier,
in advance of the decision being made, Client certifi es and agrees to
provide proper additional notice to the Consumer, a copy of the Report
obtained and a Summary of Rights, as required by the FCRA. In
addition, Client agrees to provide the Consumer with Premier's address
and toll-free number, as well as a notice of their right to dispute the
accuracy of the Consumer Report provided to the Consumer. Client
acknowledges that adverse actions include all business, credit, and
employment actions affecting Consumers that can be considered to
have a negative impact such as unfavorably changing credit or contract
terms or conditions, denying or canceling credit or insurance, offering
credit on less favorable terms than requested, or denying employment
or promotion.
2. SERVICES
A) Client hereby retains Premier to provide, and Premier hereby
agrees to provide the Services indicated on the Consumer Report User
Agreement for the permissible purpose(s) indicated.
B) Client will ensure that all information received from Premier
hereunder in used in strict compliance with all provisions of the FCRA,
the Drivers Privacy Protection Act, as applicable, the Americans with
Disabilities Act (ADA 1990), and all other applicable federal and state
laws and regulations including (if applicable) federal and state equal
opportunity laws and regulations.
C) Client will execute and deliver to Premier any documents and forms
as Premier deems necessary to provide to Client Services under any
requirements of governmental data sources and Consumer Reporting
agencies for which Premier is a reseller, or under applicable laws and
regulations. Client is responsible for maintaining all required forms for a
period as long as state and federal law dictates.
D) Premier will follow reasonable quality assurance procedures with
respect to obtaining Reports hereunder. However, Client recognizes
that information within such Reports is obtained and managed by fallible
sources and Premier does not guarantee or ensure the accuracy or
depth of information provided.
E) The parties acknowledge and agree that Premier, its Offi cers,
Managers, Employees and Owners will not be deemed to be providing
legal advice to Client in connection with the Services.
F) Client shall not use Premier's or its affi liates' names or marks without
Premier's prior written consent.
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G) Prior to the commencement of Premier's provision of Services,
Client shall designate in writing to Premier the name of one person who
shall serve as the Client's Primary Authorized User ("Client Contact")
for the Services. Client hereby represents and warrants to Premier
that the Client Contact has, and shall at all times have, the requisite
authority to (i) transmit information, directions and instructions on
behalf of Client and (ii) issue, execute, grant, or provide any approvals
(other than amendments to this Agreement), requests, notices, or
other communications required or permitted under this Agreement or
requested by Premier in connection with the Services.
H) If Client requests additional Services not specifi ed in this Agreement,
and Premier agrees to provide such Services, (i) such Services will
be subject to the applicable terms of this Agreement, and (ii) unless
otherwise agreed in writing, Client will pay Premier's then prevailing fees
for any such Services.
I) EXCEPT AS EXPRESSLY SET FORTH IN THIS AGREEMENT,
PREMIER EXPRESSLY DISCLAIMS ANY WARRANTY, EXPRESSED
OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY
OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE,
NON-INFRINGEMENT, NON-INTERRUPTION OF USE, AND
FREEDOM FROM PROGRAM ERRORS WITH RESPECT TO THE
SERVICES.
J) This provision applies to any Services which are provided via the
Internet or which Client may access via the Internet. The security of
transmissions over the Internet cannot be guaranteed. Premier is not
responsible for (i) Client's access to the Internet, (ii) interception or
interruption of communications through the Internet, or (iii) changes to
or losses of data. In order to protect Client's data, Premier may suspend
Client's use of Premier Services via the Internet immediately, without
notice, pending an investigation, if any breach of security is suspected.
K) Client acknowledges that the fi nal decision to employ, promote,
retain, terminate, lend to, lease to, insure or otherwise engage or not
engage in a legitimate business transaction with a Consumer is at the
sole discretion of the Client.
3. PAYMENTS, FEES AND TAXES;
A) Client shall pay Premier for Services including fees assessed by
governmental data sources, Consumer Reporting Agencies for which
Premier is a reseller, counties, states and institutions at the rates set
forth by Premier, provided, however, that Premier may increase prices
at any time with or without prior notice to Client. If any change in the
implementation of the Services occurs that requires Premier to devote
resources, expend time or otherwise incur costs not contemplated
by this Agreement, Client agrees to pay such additional costs as are
required in accordance with Premier's standard change control policy.
B) Client will pay to Premier all applicable sales, use or similar taxes
levied or based on this Agreement.
C) Accounts not paid within 30 days will be assessed the greater of
$5.00 per month or a fi nance charge of 1.75% per month. In case of
payment default, user is responsible for any and all collection costs,
attorney fees, reasonable costs and interest within the state laws.
4. LIABILITY
A) Premier's liability under this Agreement for damages under any
circumstances for claims of any type or character arising from or related
to the Services will be limited in each instance to the amount of actual
damages incurred by Client, provided however, that in no event will
Premier's aggregate liability hereunder during any calendar year exceed
the average monthly fee paid by Client to Premier for the Services
during such calendar year except to the extent such claims arise
out of Premier's failure to comply with applicable law. IN NO EVENT
WILL EITHER PARTY BE RESPONSIBLE FOR SPECIAL, INDIRECT,
INCIDENTAL, CONSEQUENTIAL OR OTHER SIMILAR DAMAGES
IN CONNECTION WITH THE SERVICES, EVEN IF IT HAS BEEN
ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
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B) Each of Premier and Client will use reasonable efforts to mitigate
any potential damages or other adverse consequences arising from or
related to the Services. Nothing in this Agreement is intended to limit
either party's obligation to mitigate damages.
C) Premier and the Client shall not be liable for any delay or failure to
perform under this Agreement resulting, directly or indirectly, from strike,
fi re, war, insurrection, riot, power failure or a circumstance beyond
Premier's reasonable control. In case of errors or lost data caused
by power failure, mechanical diffi culties with information storage and
retrieval systems, or other events not attributable to its own negligence or
willful misconduct, Premier's sole obligation will be to use its reasonable
efforts to reconstruct any records maintained by Premier and to amend
any Reports prepared by it which may have been affected by such
event, at its own expense.
D) The parties acknowledge that the fees for Services to be provided
hereunder refl ect the allocation of risk as set forth in this Section 4. This
Section 4 sets forth the full extent of Premier's liability hereunder for any
claim against Premier, and sets forth Client's sole remedies.
5. TERM AND TERMINATION
A) This Agreement shall continue in effect until terminated as set forth
herein. Either party may terminate this Agreement at any time on 30
days prior written notice. If Client fails to pay any amount due hereunder
within 30 days after the due date thereof then Premier may terminate
this Agreement immediately without notice to Client.
B) If either party (a) defaults in the performance of its obligations
hereunder and such failure continues for a period of 15 days after
receipt of written notice thereof (specifying in reasonable detail the
nature of such failure), (b) commits an act of bankruptcy or becomes the
subject of any Bankruptcy Act proceeding or becomes insolvent, or if
any substantial part of its property becomes subject to any levy/seizure,
assignment, application or sale for or by any creditor or governmental
agency, or (c) has any material adverse change in its fi nancial condition,
then, in any such event, the other party may, upon written notice thereof,
terminate this Agreement.
C) Within 5 days following Premier's request, Client shall make
available to Premier for audit, such records as Premier requires under
any audit requirements of governmental data sources and Consumer
Reporting agencies for which Premier is a reseller, and to review Client's
compliance with all applicable laws and regulations relating to the
Services being provided to Client.
D) If Premier determines that Client has failed to comply with any
provision of Statement of Terms of this agreement, or, after a sustained
period of account inactivity, Premier may, at its sole discretion,
immediately terminate Services.
E) If the Services are terminated pursuant to this Section 5, Client will
immediately pay all fees and charges invoiced by Premier to Client,
and shall pay to Premier promptly upon invoice all amounts due for
Services provided up to the date of termination. Upon termination of
this Agreement, all rights granted to Client hereunder will become null
and void, all materials provided by either party to the other hereunder
will be returned promptly and Premier shall have no further duties or
responsibilities to Client with respect to the Services.
6. NON DISCLOSURE AND CONFIDENTIALITY
A) All Confi dential Information disclosed hereunder will remain the
exclusive and confi dential property of the disclosing party.
B) The receiving party will not disclose the Confi dential Information of
the disclosing party and will use at least the same degree of care in
protecting the Confi dential Information of the disclosing party as it uses
with respect to its own confi dential information. The receiving party will
limit access to Confi dential Information to its employees with a need
to know and will instruct such employees to keep such information
confi dential. Notwithstanding the foregoing, the receiving party may
disclose Confi dential Information to the extent necessary to comply
with any law, ruling, regulation or rule applicable to it or to the extent
necessary to enforce its rights under this Agreement.
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C) In addition, Premier may also disclose Client Confi dential Information
(i) to the extent that disclosure of such information is required to perform
the Services, or (ii) as Premier requires under any requirements of
governmental data sources and Consumer Reporting Agencies for
which Premier is a reseller, or under applicable laws and regulations
(including, without limitation, in connection with an audit or regulatory
examination by a governmental authority).
D) For purposes of this Section, "Confi dential Information" shall mean:
all information of a confi dential or proprietary nature provided by the
disclosing party to the receiving party for use in connection with the
Services, but does not include (a) information that is already known by
the receiving party without an obligation of confi dentiality, (b) information
that becomes generally available to the public other than as a result of
disclosure by the receiving party in violation of this Agreement, and (c)
information that becomes known to the receiving party from a source
other than the disclosing party on a non-confi dential basis. Confi dential
Information of Premier also includes any Premier operating guidelines
which may be provided hereunder and all trade secrets, processes,
proprietary data, information or documentation related thereto of Premier
or its affi liates and any pricing or product information furnished to Client
by Premier or its affi liates.
7. ESTABLISHING ADDITIONAL ACCOUNTS
A) Upon written request of the Client, Premier may make additional
Consumer Report User accounts available to Client.
B) Client will provide such information, as Premier requires for
establishing additional accounts.
C) Client will ensure that the additional accounts established at the
request of the Client by Premier are used for Permissible Purposes
only, and only in accordance with applicable law. The only Permissible
Purposes for additional accounts are described in Section 1,(B),(i) of
this Statement of Terms and Conditions.
D) Client certifi es and agrees to ensure that the additional accounts and
all information received from Premier are used in strict compliance with
all the provisions of this Statement of Terms and Conditions hereunder
and with the FCRA, the Drivers Privacy Protection Act, as applicable,
the Americans with Disabilities Act (ADA 1990), and all other applicable
federal and state laws and regulations including (if applicable) federal
and state equal opportunity laws and regulations.
E) Client will provide a copy of these terms to all persons in client
organization to whom these terms and conditions may apply.
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Your signature below grants Premier permission to establish one or
more Consumer Report User Accounts, to check your organization's
credit or, as required, the credit information of its principals and,
as required, inspecting your organization to determine the exact
nature of it. Your signature also certifi es that you have read and
agree to abide by all the terms and conditions of this Consumer
Report User Agreement and that you have provided a copy of these
terms and conditions to all persons in your organization to whom
these terms and conditions may apply.
Client Authorization
I agree that a fax or photocopy of this authorization is to
be considered and accepted with the same authority as
the original.
Organization Legal Name
Organization Legal Street Address
City / State / Zip
Authorized By (Print or Type Name)
Title
Signature
Date
Note: Client Signatory must have authority to legally bind the client.
Premier Authorization
Authorized By (Print or Type Name)
Title
Signature
Date
Copyright © 2005