Accurate Information Services
PO Box 2332
Woonsocket, RI., 02839
Phone: 401-447-2839 / Fax: 401-427-0292
(Please fax this form to the above number, a member of our office will contact you shortly.)
Name_____________________________________________________________Date______/______/_______
Firm
Name (If Applicable)________________________________Type of
Business_________________________
Address______________________________________City____________________State______Zip__________
E-mail
Address______________________________________________________________________________
Home
Phone #_______________________Day #________________________Fax
#______________________
(Please
Complete One of the Following) Social Security #
____________________________________________or
Drivers
License #______________________________or Federal Tax ID
#_______________________________
I
intend to use this reports for: [
]Employment Screening [
]Tenant Screening [
]Judgment
[
]Line of Credit [ ]Property Management [
] Other ________________________________________
By Invoice: [ ]Credit Card: [ ] Visa [ ] MasterCard [ ]
Name
of
Cardholder__________________________________________________________________________
Credit
Card #__________________________________________________Expiration
Date__________________
Signature____________________________________________________________Date______/______/______
****WARNING/CONFIDENTIAL****
This
message is intended only for the use of the individual or entity to which it
is addressed and/or faxed and may contain information that is privileged, confidential and
exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient, you are
hereby notified that any dissemination, distribution or copying of this
communication is strictly prohibited. If you have received this communication
in error, please notify the sender by telephone immediately (401 447-2839).
Thank you for your cooperation