Signup Account Information Company or Business Legal Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Promo Code Number of Employees * Permissible Purpose Check all that apply Section 604(a)(1) Section 604(a)(1). As ordered by a court or federal grand jury subpoena. Section 604(a)(2) Section 604(a)(2). As instructed by the consumer in writing. Section 604(a)(3)(A) Section 604(a)(3)(A). For the extension of credit as a result of an application from a consumer, or the review or collection of a consumer’s account. Section 604(a)(3)(B) Section 604(a)(3)(B). For employment purposes including evaluating a consumer for employment, promotion, reassignment or retention as an employee, where the consumer has given prior written permission. Section 604(a)(3)(C) Section 604(a)(3)(C). For the underwriting of insurance as a result of an application from the consumer. Section 604(a)(3)(D) Section 604(a)(3)(D). To determine a consumer’s eligibility for a license or other benefit granted by a governmental instrumentality required by law to consider an applicant’s financial responsibility or status. Section 604(a)(3)(E) Section 604(a)(3)(E). For use by a potential investor or servicer, or current insurer, in evaluating and/or assembling the credit or prepayment risk associated with an existing credit obligation. Section 604(a)(3)(F)(i) Section 604(a)(3)(F)(i). Where there is a legitimate business need, in connection with a business transaction that is initiated by the consumer. Section 604(a)(3)(F)(ii) Section 604(a)(3)(F)(ii). To review a consumer’s account to determine whether the consumer continues to meet the terms of the account. Section 604(a)(4) or (5) Section 604(a)(4) or (5). For use by state and/or local officials in connection with the determination of child support payments, or modifications and enforcement thereof. Authorized Agent Authorized Agent Name * Title * Contact Name (if different from above) Telephone * Email Address * Fax Website Effective Date Authorized Users (optional) Add additional authorized users. Each user will receive a secure login ID and password. This is optional. Authorized User 1 Name Title Phone Fax Email Authorized User 2 Name Title Phone Fax Email Authorized User 3 Name Title Phone Fax Email Authorized User 4 Name Title Phone Fax Email Hire Image Client Agreements You must agree to the terms of use and to comply with the requirements of Hire Image's client agreement before using services. Click the link below to access the End-User Agreement. Please print and save a copy for your records. When you're done, check the corresponding box to indicate you agree with and will comply with the terms of use and requirements, fill in the required fields, and submit the agreements. After we receive your submittal, Hire Image will review your agreement. Our procedure is to identify and authenticate all client submittals to determine eligibility. We may contact you for more information during this process. If the account is qualified, we then send you a username and temporary password to access the Hire Image background screening system. We will also provide you with forms for your applicants. If you have any questions, please call 888-433-0090. End-User Agreement * I agree to the terms of the End-User Agreement Consent RequestThis form collects your information so that Hire Image can communicate with you and provide assistance. Please check our Privacy Policy to see how we protect and manage your submitted data. Consent Request * I consent to having Hire Image collect my information via this form If you are human, leave this field blank.
