800.820.9029 Fax 818.567.1215 215 W. Alameda Ave., Burbank, CA 91502 CA PI 6277 Initial ______

Service Application PRIVACY STATEMENT

Client’s information requested herein will be held in the strictest of confidence by Frasco, Inc., and will be used solely for the purposes of account setup and management.

ORGANIZATION Organization Name: DBA (if applicable): Year Established: Website: Physical Address: City: State: Zip: Mailing Address (if different): City: State: Zip: Account Administrator: Title: Email: Phone: Fax: Invoice / Billing Contact: Title: Email: Phone: Fax: EIN/SSN: Business Type: Corporation LLC Partnership* Individual/Sole Proprietor* * A Service Agreement Supplement must be completed by partnerships and individuals/sole proprietors

Industry (e.g. banking, transportation, manufacturing, healthcare): Nature of Business (e.g. credit union, airline, automobile maker, hospital):

BUSINESS REFERENCES Reference Company 1: Type of Account: Contact Name: Phone: Reference Company 2: Type of Account: Contact Name: Phone: Reference Company 3: Type of Account: Contact Name: Phone:

COMPLIANCE SERVICES The following services are fee-based and require setup. Please indicate whether you would like them to be activated.

Yes No Applicant Report Copy: Frasco Profiles will send CA, MN and OK applicants a copy of their report via email when they tick a checkbox on the Disclosure & Authorization Form indicating that they want to receive a copy.

Yes No Adverse Action: Frasco Profiles will administer the process of sending documentation to an applicant (via email) pursuant to FCRA Adverse Action requirements when Client indicates after viewing their completed report.

DUE DILIGENCE

800.820.9029 | Fax 818.567.1215 | www.frascoprofiles.com | 215 W. Alameda Ave., Burbank, CA 91502 | CA PI 6277 Initial ______Service Application As part of the consumer reporting industry’s efforts to prevent identity theft, Frasco, Inc. is required to conduct “know your client” due diligence, including asking the questions below, and conducting a site visit of Client’s place of business. Client may be charged an account setup fee of $95 related to this required due diligence process and this fee may be incurred each time Client’s physical location changes. Does Client have a business license? Yes No If yes, name the issuer (e.g. city, county) and provide a copy of your license. Is Client public and regulated by the SEC? Yes No If yes, provide ticker symbol. Is Client a licensed insurance company? Yes No If yes, provide a copy of your license. Is Client a 503(c)(3) Non-Profit? Yes No If yes, provide a copy of certificate. Is Client a certified small business? Yes No If yes, provide a copy of certification. Is Client a DOT DBE? Yes No If yes, provide supporting documentation. Is Client listed with any of the following? AM Best Moody’s Standard and Poor’s FDIC NCUA

AUTHORIZED USERS Please list additional authorized end users below. If necessary, we can provide you with an additional form. End User Name: Title: Email: Phone: Address (if different): City: State: Zip: End User Name: Title: Email: Phone: Address (if different): City: State: Zip: End User Name: Title: Email: Phone: Address (if different): City: State: Zip: End User Name: Title: Email: Phone: Address (if different): City: State: Zip:

CERTIFICATION

I acknowledge and agree that Frasco, Inc. is not acting as legal counsel and that it is Client’s responsibility to comply with all laws pertaining to the information provided by Frasco, Inc. I certify that all consumer reports governed by this agreement will be used for employment purposes only (FCRA permissible purpose: employment).

I, the undersigned hereby attest that I have direct knowledge of the facts certified in this Service Application.

Authorized Signature: Date: Printed Name: Title:

800.820.9029 | Fax 818.567.1215 | www.frascoprofiles.com | 215 W. Alameda Ave., Burbank, CA 91502 | CA PI 6277 Initial ______