Business Credit Order App

Business Credit Reports Order Form PRINT-COMPLETE-SIGN-FAX TO 626 398-0642 Name__________________________________________________________Date_____/_____/_______ Firm Name (If Applicable)_____________________________Type of Business____________________ Address___________________________________City_________________State______Zip__________ E-mail Address________________________________________________________________________ Phone #__________________________________Fax #_______________________________________ Credit Card you wish Billed?

[ ] Visa [ ] Mastercard [ ] Discover [ ] Amex

Name of Cardholder____________________________________________________________________ Credit Card #__________________________________________Expiration Date__________________ I have read and understand the Fair Credit Reporting Act and agree to abide by it in its entirety. I also agree to terms of the (included) Security Access Requirements Agreement. Signature______________________________________________________Date_____/_____/_____ I wish to order a [ ] U.S. Business Credit Report [ ] U.S. DNB Report Firm Name _________________________________________Type of Business____________________ Address___________________________________City_________________State______Zip__________ E-mail Address________________________________________________________________________ Phone #__________________________________Fax #_______________________________________ Other info____________________________________________________________________________ _____________________________________________________________________________________

Accurate Credit Bureau 1792 E. Washington Blvd. Pasadena CA. 91104 Phone 626 798-6670 Fax 626 398-0642 www.accuratecredit.com