SHDP CREDIT RESTORATION CONTRACT, ELECTRONIC SIGNATURE & LIMITED POWER OF ATTORNEY
|
|
- Gerald Floyd
- 5 years ago
- Views:
Transcription
1 SHDP CREDIT RESTORATION CONTRACT, ELECTRONIC SIGNATURE & LIMITED POWER OF ATTORNEY You have contracted SHDP ("Self Help Document Preparation") to restore your credit. SHDP will utilize all applicable remedies permissible by law in challenging items on your credit report which you have identified as inaccurate or questionable. You may cancel this agreement within the first five days with no further obligation. In consideration of SHDP credit restoration services you agree to the following: 1) I agree to provide SHDP with a legible current copy of my credit report a copy of current Driver s License or State ID and a legible copy of my (our) Social Security Card. 2) I agree to cooperate with SHDP in the review of my (our) credit history and the identification of all inaccurate or questionable items on my (our) credit report. 3) I agree to pay SHDP the promotional fee of $ or $ if I sign up with my spouse. I agree to a six month term of service. The initial setup fee includes $ administrative fee which is non- refundable after sign up date. The six month term does include the administrative fee. 4) I agree to provide SHDP with legible copies of all updated credit reports and correspondence which I receive from the credit bureaus during the span of the contract service. 5) I agree to promptly notify SHDP of any change of my (our) name, address, or contact information while under contract. 6) I agree SHDP will systematically dispute questionable and erroneous items contained in your credit report by preparing signing and sending letters to the credit bureaus and collectors, as deemed appropriate, on your behalf and in your name. Date: Date: Signature: Signature: "By checking this box and providing my Social Security Number I certify that I am at least 19 years of age, acknowledge that I have read the legal disclosures, and give my electronic signature and limited power of attorney for SHDP to perform work on my behalf" you are representing and agreeing that you accept all terms and conditions as if you had physically provided your signature. Affiliate Name: First Last: ID #
2 EXPLANATION OF FEES AND SERVICES Initial set up constitutes as data entry into our software in preparation for starting the credit restoration process, data verification, and setup of a customer file. If client cancels contract after 5 day period and there have been removal of erroneous, negative, or unverifiable items, a fee of $50.00 per individual item per credit reporting bureau will be deducted from balanced left if any. Not including the $ administrative fee which is non- refundable. The total promotional costs are $ for an individual; OR $ for a couple for a six month period of service. SHDP reserves the right to change price of service at anytime. This will not affect clients under contract if change occurs. For the duration of the contract SHDP will systematically dispute questionable and erroneous items contained in your credit report by preparing and sending letters to the credit bureaus and collectors, as deemed appropriate, on your behalf and in your name. On an ongoing basis we will monitor the results, continue our efforts, and consult with you as needed. SHDP cannot predict exactly how long the process will take. The duration of the program is entirely dependent on the number of accounts that we will be disputing. In most cases, this takes approximately six months; however it may take more or less time depending on your case. ELECTRONIC SIGNATURE By checking the box on our application form that states: "By checking this box and providing my Social Security Number I certify that I am at least 19 years of age, acknowledge that I have read the legal disclosures, and give my electronic signature and limited power of attorney for SHDP to perform work on my behalf" you are representing and agreeing that you accept all terms and conditions as if you had physically provided your signature.
3 LIMITED POWER OF ATTORNEY This is a Limited Power of Attorney providing SHDP with the permission to represent you in accordance with this agreement. Your Limited Power of Attorney authorizes and directs SHDP to act as your disclosed or undisclosed agent when performing the services you have retained SHDP to provide. For the duration of this Limited Power of Attorney we will write, sign, and send letters to the credit bureaus, creditors, and collectors, as deemed appropriate, in your name and on your behalf. Date: Date: Signature: Signature:
4 You may cancel your Limited Power of Attorney at anytime by sending SHDP a statement in writing via electronic mail or postal mail stating that you retract your electronic authorization. Without this electronic authorization and Limited Power of Attorney, SHDP is unable to represent you, and canceling it will terminate this Agreement. Our Contact Information: SHDP Alessandro Blvd # Moreno Valley CA, Office: Fax: legallyrestorecredit@gmail.com
5 INFORMATION STATEMENT Consumer Credit File Rights Under State and Federal Law (Pursuant to Credit Repair Organizations ACT, 15 U.S.C 1679D) Carefully read the following before deciding to do business with us. We are committed to your satisfaction, as well as your full understanding of the State and Federal laws that regulate our conduct towards you. You have a right to bring a civil action for damages against a Credit Repair Organization that violates any provision of the Credit Services Act of Please make certain that the information you provide to us is accurate. It is a violation of State and Federal law to make any statement which is untrue or misleading and which is known, or which by the exercise of reasonable care should be known, to be untrue or misleading, to a consumer credit reporting agency. In addition, it is illegal for you to make, or for a company like SHDP to assist you to create, a new credit record by using a different name, address, social security number, or employee identification number. You have a right to obtain a copy of your credit file from a consumer credit reporting agency. You may be charged a reasonable fee. There is no fee, however, if you have been turned down for credit, employment, insurance, or a rental dwelling because of information in your credit report within the preceding 60 days. The consumer credit reporting agency must provide someone to help you interpret the information in your credit file. You have a right to dispute inaccurate information by contacting the consumer credit reporting agency directly. However, neither you nor any credit repair company or credit services organization has the right to have accurate, current, and verifiable information removed from your credit report. Under the Federal Fair Credit Reporting Act (FCRA), the consumer credit reporting agency must remove accurate, negative information from your report only if it is over seven years old. Bankruptcy information can be reported for 10 years. If you have notified a credit reporting agency in writing that you dispute the accuracy of information in your credit file, the consumer credit reporting agency must then reinvestigate and modify or remove inaccurate information. The consumer credit reporting agency may not charge a fee for this service. Any pertinent information and copies of all documents you have concerning an error should be given to the consumer credit reporting agency. If the Credit Reporting Agency s reinvestigation does not resolve the dispute to your satisfaction, you may send a brief statement to the consumer credit reporting agency to keep in your file, explaining why you think the record is inaccurate. The consumer credit reporting agency must include your statement about disputed information in any report it issues about you. The Federal Trade Commission regulates the Credit Reporting Agencies and Credit Repair Organizations. For more information, contact: The Public Reference Branch, Federal Trade Commission, Washington, D.C You have a right to cancel the contract for any reason within five working days from the date you signed it. If for any reason you do cancel the contract during this time, you do not owe any money. You have a right to sue a credit services organization if it misleads you.
6 SHDP RIGHT OF CANCELLATION: You may cancel this Agreement without penalty or obligation at any time before midnight on the fifth business day following the date on which you signed this agreement. See the attached Notice of Cancellation form for an explanation of this right. Date: Date: Signature: Signature:
7 IMPORTANT INSTRUCTIONS: When signing your Limited Power of Attorney having it notarized is optional, however recommended. The main reason is if the Bureaus sends a letter back questioning the authenticity of your letters and your identity, you and SHDP will have verified proof from the Notary Public that you are truly the person that is disputing the erroneous, negative or unverified information in your report. If outside the State of California you still should go to your local Notary Public in your State and follow the same steps when signing your Limited Power of Attorney.
8 RIGHT OF CANCELLATION Notice of Cancellation. I (we) are cancelling services with SHDP. I (we) understood the terms of the agreement and if entitled to a full or partial refund expect to receive that refund within 30 days of cancellation. Furthermore I (we) recognize that there may be some portion not refundable if cancellation occurs after the first 5 days of signing the contract for service, which includes the $ Administration fee, in addition to any erroneous, negative, or unverifiable item(s) removed from my (our) Credit Report per individual which cost $50.00 per item per Credit Bureau, which is a separate cost. Date: Date: Signature: Signature:
9 ATTACH COPY OF DRIVERS LICENSE OR STATE IDENTIFICATION CARD ATTACH COPY OF SOCIAL SECURITY CARD ATTACH COPY OF CURRENT UTILITY BILL OR CURRENT PAY CHECK STUBB IF ADDRESS IS DIFFERENT ON DRIVERS LICENSE OR IDENTIFICATION CARD
10 ACKNOWLEDGMENT State of California County of ) On before me, (insert name and title of the officer) personally appeared, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Seal)
Lexington Law Firm Payment Information Form
Lexington Law Firm Payment Information Form A Valid Active Email Address Is Required. Please Print Your Email Address Below PERSONAL INFORMATION FIRST NAME: LAST NAME: ADDRESS: CITY: HOME PHONE: WORK PHONE:
More informationOnce you get everything together, you can fax your documents to (480) or to
Thank you for enrolling in the Truly Fair Credit Program of Total Credit Restoration. To get started, you will need to read and follow the instructions below. Please read the entire welcome packet as it
More informationCREDIT RX AMERICA LLC STATE DISCLOSURE
CREDIT RX AMERICA LLC STATE DISCLOSURE 1. Complete and Detailed description of Services to be performed by Credit RX America LLC, et al, hereinafter referred to as "CRA". Our services are "Ala Carte" and
More informationApplication to Renew Cannabis Retail License 2019 (No Changes)
County of Santa Cruz Cannabis Licensing Office 701 Ocean Street, Room 520 Santa Cruz, CA 95060 831-454-3833 Cannabisinfo@santacruzcounty.us Application to Renew Cannabis Retail License 2019 (No Changes)
More informationUpgrade My Credit Client Agreement
Upgrade My Credit Client Agreement 901 W. Bardin Rd. Suite 306 Arlington, Texas 76017 817-886-0302 off. 817-887-0816 fax www.upgrademycredit.com APPLICANT INFORMATION Mr. Mrs. Ms. PLEASE PRINT CLEARLY
More information-Client Copy- Consumer Credit File Rights Under State and Federal Law
-Client Copy- Consumer Credit File Rights Under State and Federal Law You have a right to dispute inaccurate information in your credit report by contacting the credit bureau directly. However, neither
More informationCity and County of San Francisco Employees Retirement System
City and of San Francisco Employees Retirement System POWER OF ATTORNEY INSTRUCTIONS PLEASE READ CAREFULLY BEFORE YOU SUBMIT YOUR POWER OF ATTORNEY, AS ADDITIONAL DOCUMENTATION IS REQUIRED FOR PROCESSING
More informationCALIFORNIA DURABLE POWER OF ATTORNEY (California Probate Code Section 4401)
CALIFORNIA DURABLE POWER OF ATTORNEY (California Probate Code Section 4401) NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF
More informationApplication for License, Permit and Miscellaneous Bonds BOND INFORMATION
Surety Group Application for License, Permit and Miscellaneous Bonds A BOND INFORMATION Bond Number: TYPE OF BOND BOND AMOUNT REQUESTED EFFECTIVE DATE BOND TO BE FILED WITH (OBLIGEE) ADDRESS OF OBLIGEE
More informationA Summary of Your Rights Under the Fair Credit Reporting Act
A Summary of Your Rights Under the Fair Credit Reporting Act Under the federal Fair Credit Reporting Act, an employer is required to provide the individual with a copy of the official description of individual
More informationDistribution Election Form Application & Authorization
Landscape, Irrigation & Lawn Sprinkler Industry Trusts Defined Contribution Pension Trust c/o Southern California Pipe Trades Administrative Corporation 501 Shatto Place, 5 th Floor, Los Angeles, California
More informationNorthern California Pipe Trades Supplemental Pension Plan
Northern California Pipe Trades Supplemental Pension Plan TO: FROM: SUBJECT: Participants and Beneficiaries of Northern California Pipe Trades Supplemental Pension Plan The Board of Trustees, acting as
More informationCHANGE REQUEST: TRUST CERTIFICATION
CHANGE REQUEST: TRUST CERTIFICATION Complete the following with your current personal information and indicate the account(s) requesting to be changed. Customer Name: Account Number(s): By signing below
More informationMinimum Distribution Request
Minimum Distribution Request Section A. Plan Sponsor Information Plan Sponsor Name Contract/Account No. Affiliate No. Section B. Member Information Social Security No. of Birth (mm/dd/yyyy) First Name/Middle
More informationRETIREMENT APPLICATION INSTRUCTIONS (Page 1 of 2)
NORTHERN CALIFORNIA PIPE TRADES TRUST FUNDS FOR UA LOCAL 342 935 Detroit Avenue, Suite 242A, Concord, CA 94518-2501 Phone 925/356-8921 Fax 925/356-8938 tfo@ncpttf.com www.ncpttf.com RETIREMENT APPLICATION
More informationCITY OF SIGNAL HILL Cherry Avenue Signal Hill, CA
CITY OF SIGNAL HILL 2175 Cherry Avenue Signal Hill, CA 90755-3799 AGENDA ITEM TO: FROM: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL STEVE MYRTER, P.E. DIRECTOR OF PUBLIC WORKS SUBJECT: RESOLUTION DECLARING
More informationINLAND. Distribution Election Form Application, Spouse s Consent & Authorization
INLAND Refrigeration & Air Conditioning Retirement Trust Fund 501 Shatto Place, 5 th Floor, Los Angeles, CA 90020 (213) 385-6161 (800) 595-7473 (213) 385-2767 (fax) Distribution Election Form Application,
More informationDISCLOSURE OF INTENT TO OBTAIN CONSUMER REPORTS
BACKGROUND CHECK FORMS FOR VOLUNTEER: Cru-High School Global Missions Instructions to Applicant: Sign and return pages 1, 2, & 5; (keep pages 3 & 4). Please mail the signed pages with a $20 check payable
More informationSouthern California Pipe Trades
Southern California Pipe Trades LO56050514 (Retired) Defined Contribution Fund Retirement/Disability/Termination Distribution LO56050517 (Disabled) Application Complete all applicable sections and return
More informationPursuant to the FCRA & the FDCPA I now exercise my lawful right to question the validity of this debt your agency claims has come due.
Debt Validation Sample Letter Date To: (Name of the Collections Agency) Address: (Address of the Collection Agency) Account # 123456787 From: (Your Name) Address: (Your Address) Delivery Confirmation #:
More informationRENTAL APPLICATION INSTRUCTIONS
RENTAL APPLICATION INSTRUCTIONS 1) Every adult who will live in the unit must submit a separate application. Any co-signer on the lease must also fill out a separate application. 2) The application must
More informationDeductible Reimbursement Proof of Loss Claim #:
Deductible Reimbursement Proof of Loss Claim #: Please be advised that this is a generic claim form and may refer to several types of coverages. This does not imply or suggest that your policy contains
More informationSouthern California Pipe Trades
Southern California Pipe Trades LO56050505 Defined Contribution Fund Hardship Withdrawal Application Complete all applicable sections and return pages 1-4 to: Southern California Pipe Trades Administrative
More informationINSTRUCTIONS FOR FICTITIOUS BUSINESS NAME (FBN) STATEMENT AND AFFIDAVIT OF IDENTITY
INSTRUCTIONS FOR FICTITIOUS BUSINESS NAME (FBN) STATEMENT AND AFFIDAVIT OF IDENTITY The form must be legible no erasures or whiteouts. Strikeovers acceptable if accompanied with initials. 1. IN PERSON:
More informationPromissory Note Set-Up Form
Promissory Note Set-Up Form The information contained in this Form is needed to set up your promissory note on our servicing system or that of the servicer listed below. The full completion of this Form
More informationTHE INTEGRITY CENTER objective risk management information A Unit of Integrity Centers Corporation
THE INTEGRITY CENTER objective risk management information A Unit of Integrity Centers Corporation TM Suite 1008 2828 Forest Lane Dallas, Texas 75234 (972) 484-6140 (800) 456-1811 FAX (972) 484-6381 http://www.integctr.com/
More informationREQUEST FOR ANNUAL PRE-QUALIFICATION OF PUBLIC WORKS CONTRACTORS
STANISLAUS COUNTY OFFICE OF EDUCATION 1100 H STREET MODESTO, CA 95354 REQUEST FOR ANNUAL PRE-QUALIFICATION OF PUBLIC WORKS CONTRACTORS Requested for Pre-Qualification Issued: December 8, 2017 Responses
More informationSan Mateo County Reissued Mortgage Credit Certificate Program Application For Reissued Mortgage Credit Certificate
Main Office Department of Housing 264 Harbor Blvd., Building A Belmont, CA 94002 017 Housing Community Development Tel: (650) 802 5050 Housing Authority of the County of San Mateo Tel: (650) 802 3300 Board
More informationALABAMA BILL OF RIGHTS
ALABAMA BILL OF RIGHTS Alabama Consumers Have the Right to Obtain a Security Freeze. You have a right to place a security freeze on your credit report, which will prohibit a consumer reporting agency from
More informationTransfer on Death Agreement
Transfer on Death Agreement Please use this form to designate individual(s) or trust(s) that you would like to receive assets in your Merrill Edge brokerage account upon your death without going through
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT Return by mail or fax to: Fort Sill Federal Credit Union Attn: Human Resource Officer PO Box 1527 Lawton, OK 73502-1527 580-353-2124 Fax 580-250-8177 We consider applicants for
More informationI/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below.
Dear Fiduciary Support: I/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below. 1. Choose one: I/We have already
More informationFOR OFFICE USE ONLY DISCLOSURE OF PROCUREMENT OF CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT
FOR OFFICE USE ONLY School District Knox County Schools Account Number: 408913 School Contact: School Phone Number: School Email: School Name: DISCLOSURE OF PROCUREMENT OF CONSUMER REPORT AND/OR INVESTIGATIVE
More informationPenn State Health CONSENT AND AUTHORIZATION FORM ADDITIONAL STATE LAW NOTICES
Penn State Health CONSENT AND AUTHORIZATION FORM The Penn State Milton S. Hershey Medical Center, (the Company ) may request background information about you from a consumer reporting agency in connection
More informationDisclosure Regarding Background Investigation
Disclosure Regarding Background Investigation To authorize your background check, please carefully read the Disclosure Agreement and fill out the information below including your full legal name as it
More informationDisclosure and Authorization Concerning Consumer Reports and Investigative Consumer Reports
Disclosure and Authorization Concerning Consumer Reports and Investigative Consumer Reports THIS AUTHORIZATION COMPLIES WITH FEDERAL LAW AND ALL STATE LAWS EXCEPT CALIFORNIA, MAINE, MINNESOTA, NEW YORK
More informationCITY OF SHAVANO PARK EMPLOYMENT APPLICATION An Equal Opportunity Employer
CITY OF SHAVANO PARK EMPLOYMENT APPLICATION An Equal Opportunity Employer READ CAREFULLY 1. Type or print clearly all answers in INK. 2. Complete all sections. Resumes and support documents may be attached.
More informationAPPROVED CREDIT GROUP Valley Blvd. City of Industry, CA & 4908 Peck Rd. El Monte, CA 91732
Confirmation of Agreement I agree to pay ACG the amount mentioned here as an administrative client set up fee. The administrative client set up fee is considered earned by ACG and non refundable as soon
More informationHOUSE... No The Commonwealth of Massachusetts
HOUSE.............. No. 4806 The Commonwealth of Massachusetts The committee of conference on the disagreeing votes of the two branches with reference to the Senate amendments (striking out all after the
More informationDisclosure Regarding Background Investigation
Disclosure Regarding Background Investigation To authorize your background check, please carefully read the Disclosure Agreement and fill out the information below including your full legal name as it
More informationDEED OF TRUST WITH REQUEST FOR NOTICE
RECORDING REQUESTED BY: When Recorded Mail Document To: APN: SPACE ABOVE THIS LINE IS FOR RECORDER S USE DEED OF TRUST WITH REQUEST FOR NOTICE HIS DEED OF TRUST is made this day of among the Trustor, (herein
More informationDISCLOSURE REGARDING BACKGROUND INVESTIGATION
DISCLOSURE REGARDING BACKGROUND INVESTIGATION A CONSUMER REPORT MAY BE PROCURED FOR EMPLOYMENT PURPOSES ON BEHALF OF A consumer report or investigative consumer report including information about your
More informationFederal Fair Credit Reporting Act & DPPA Summary of Individual Rights. Federal Motor Carrier Safety Regulation Rights
q Applicant Keep This Copy q Federal Fair Credit Reporting Act & DPPA Summary of Individual Rights Federal Motor Carrier Safety Regulation Rights As part of your employment background investigation with
More informationDISCLOSURE REGARDING BACKGROUND INVESTIGATION
DISCLOSURE AND AUTHORIZATION [IMPORTANT - - PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION] DISCLOSURE REGARDING BACKGROUND INVESTIGATION ( the Company ) may obtain information about you for employment
More informationEn la siguiente le estamos enviando el contrato de nuestros servicios. Favor de llenar y firmar las áreas marcadas en amarillo.
3501 W. Vine St. Suite 523 Kissimmee, FL 34741 Estimado (a): En la siguiente le estamos enviando el contrato de nuestros servicios. Favor de llenar y firmar las áreas marcadas en amarillo. Nuestro objetivo
More informationFOR OFFICE USE ONLY Hard Hat Safety Glasses: B C Y Vest String
FOR OFFICE USE ONLY Hard Hat Safety Glasses: B C Y Vest String DATE: Employee Name: Employee Number: 530 Bercut Dr. Suite G, Sacramento, CA 95811 Phone (916) 852-6030; Fax (916) 852-7258 Lic. # 985530
More informationDISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:
DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT Company Name: In connection with your application and/or employment with above listed Company (hereinafter the Company ) this
More informationDisclosure of Intent to Obtain Consumer Report and/or Investigative Consumer Report for Employment Purposes
Disclosure of Intent to Obtain Consumer Report and/or Investigative Consumer Report for Employment Purposes By this document and pursuant to the Fair Credit Reporting Act (FCRA), 4-County Electric Power
More informationCONSUMER DISCLOSURE AND AUTHORIZATION FORM. Disclosure Regarding Background Investigation
CONSUMER DISCLOSURE AND AUTHORIZATION FORM Disclosure Regarding Background Investigation Montgomery College (the Company ) may request, for lawful employment purposes, background information about you
More informationSuperior Court of California, County of San Luis Obispo
Superior Court of California, CLAIM INSTRUCTIONS and FMS If you are claiming funds in excess of $1,000 please complete the following: If you are requesting an un-cashed or stale dated check in excess of
More informationAdverse Action Guide for Employers: A Simplified Guide to the Fair Credit Reporting Act
This information presented here is not legal advice and is presented for general education purposes ONLY. BackTrack recommends that you consult with legal counsel for advice and opinions. Adverse Action
More informationThank you for your interest in employment at METEC! Please observe the following steps when applying for employment:
Dear Potential METEC Employment Applicant: Thank you for your interest in employment at METEC! Please observe the following steps when applying for employment: 1. Read the Background Verification Disclosure
More informationDISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:
DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT Company Name: In connection with your application and/or employment with above listed Company (hereinafter Company ) this
More informationAppendix A. Certificated Salary Schedules
Appendix A Certificated Salary Schedules 82 St. Helena Unified School District Certificated Salary Schedule 186 Days FY 2016/17 4.25% Applied 07/01/16 Credential BA + 30 BA + 45 BA + 60 BA + 75 BA + 90
More informationV5 Dependent Aggregate Worksheet
1 COLUMBIA COLLEGE Tysons Main Campus 8620 Westwood Center Dr. Vienna, VA 22182 Tel. 703-206-0508 Fax. 703-206-0488 Centreville Extension 5940 Centreville Crest Lane Centreville, VA 20121 Tel. 703-266-0508
More informationApplication for Employment
Application for Employment Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process
More informationAPPLICANT Full Name (Last) (First) (Ml) Date of Birth Home Phone Number ( ) Cell Phone Number ( ) Work Phone Number ( ) Area Code
Application for Residency Hunter Lafayette Properties (Every additional live-in resident over the age of 18 as of the lease commencement date must submit a separate application and sign the lease) APPLICANT
More informationRental Application for Residents and Occupants
Rental Application for Residents and Occupants Each co-applicant and each occupant 18 years old and over must submit a separate application. Spouses may submit a single application. Date when filled out:
More informationThe General and Mrs. Curtis E. LeMay Foundation APPLICATION CHECKLIST
The General and Mrs. Curtis E. LeMay Foundation APPLICATION CHECKLIST Please use this checklist to make sure that all items are included before mailing your application. The checkmark column on the left
More informationCity of Heath Heath, TX Phone: (972) Fax: (972)
City of Heath Heath, TX 75032 Phone: (972) 771-6228 Fax: (972) 961-4932 Dear Applicant, Thank you for considering the City of Heath as an employment opportunity. Applications are only accepted for posted
More informationDESIGNATION OF BENEFICIARY FORM FOR PRE-RETIREMENT DEATH BENEFITS ONLY
DESIGNATION OF BENEFICIARY FORM FOR PRE-RETIREMENT DEATH BENEFITS ONLY Please read these instructions before completing the form. Use this form to designate or change a beneficiary only for Pre-Retirement
More informationFCRA SUMMARY OF RIGHTS
FCRA SUMMARY OF RIGHTS Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552 The federal Fair
More informationMotor Vehicle Report Risk Management Authorization
Motor Vehicle Report Risk Management Authorization Department / Campus: (Check one) Occasional Driver Primary Driver Consumer Information Risk Management Office Use: DL Information verified by (Initial/Date)
More informationApplicant Name: LAST FIRST M I. Soc. Sec. # - - DOB (M/D/Y) / / Driver s License # State issued: Marital Status. Home Phone: Cell Phone:
2018 Cunningham Dr. Hampton, VA 23666 757.838.5605 Applicant Name: LAST FIRST M I Soc. Sec. # - - DOB (M/D/Y) / / Driver s License # State issued: Marital Status Home Phone: Cell Phone: EMAIL: How did
More informationBACKGROUND CHECK DISCLOSURE
BACKGROUND CHECK DISCLOSURE Mehlville Fire Protection District (the Company ) may order a consumer report (a background report) or investigative consumer report" on you in connection with your employment
More informationcheck on you, please complete the information below and include all past or current names used (e.g., maiden, surname, alias).
Personal Identifying Information Needed For Background Check To facilitate a background check on you, please complete the information below and include all past or current names used (e.g., maiden, surname,
More informationSuperior Court of California, County of El Dorado. UNCLAIMED FUNDS INSTRUCTIONS and FORMS
Superior Court of California, County of El Dorado UNCLAIMED FUNDS INSTRUCTIONS and FORMS TO MAKE A CLAIM: STEP 1: Complete the attached forms: Claim Affirmation Form and Claim For Money Held. Please type
More informationPre- Foreclosure Step By Step Compliance Checklist & Order Form
GOLDEN WEST FORECLOSURE SERVICE, INC. 611 Veterans Blvd., Suite 217, Redwood City, CA 94063-1401 Ph. (888) 982-3888 Fax. (650) 369-2261 Website: www.goldenwestforeclosure.com Email: gwfs@earthlink.net
More informationCLASS ACTION CLAIM FORM
Name(s): (Barcode) Claimant ID: Verification No.: CLASS ACTION CLAIM FORM PLEASE FULLY COMPLETE THIS CLAIM FORM AND SIGN IT BELOW. INCOMPLETE CLAIM FORMS WILL BE DEEMED INVALID AND THE CLAIM MAY BE DENIED.
More informationTENANT FORM DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT. Landlord / Property Manager:
TENANT FORM DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT Landlord / Property Manager: In connection with your rental application with the above listed Landlord/Property
More informationRequest for Name or Ownership or Beneficiary Change
The Guardian Life Insurance Company of America ( Guardian ) The Guardian Insurance & Annuity Company, Inc. ( GIAC ) Berkshire Life Insurance Company of America ( Berkshire ) Request for Name or Ownership
More informationAPPLICATION FOR EMPLOYMENT
We consider applicants without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. (PLEASE
More informationHome Address Please do not provide a P.O. Box. We can only process your application with your residential address. City State Postal Code Country
Florida Bank VISA PLATINUM CREDIT CARD APPLICATION PERSONAL INFORMATION* I accept the annual fee of US$75 for Visa Platinum and US$50 for each additional card. Title (optional) Mr. Mrs. Ms. First, Middle,
More informationApplication for Employment
Application for Employment The Plains State Bank is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, religion, sex, ancestry,
More informationKANSAS STATE UNIVERSITY
KANSAS STATE UNIVERSITY DISCLOSURE AND AUTHORIZATION [IMPORTANT PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION] DISCLOSURE REGARDING BACKGROUND INVESTIGATION PER 59(1/2013) Kansas State University
More informationDEED OF TRUST NOTICE: THIS LOAN IS NOT ASSUMABLE WITHOUT THE APPROVAL OF THE DEPARTMENT OF VETERANS AFFAIRS OR ITS AUTHORIZED AGENT.
WHEN RECORDED MAIL TO: SPACE ABOVE THIS LINE FOR RECORDER'S USE DEED OF TRUST NOTICE: THIS LOAN IS NOT ASSUMABLE WITHOUT THE APPROVAL OF THE DEPARTMENT OF VETERANS AFFAIRS OR ITS AUTHORIZED AGENT. The
More informationSage Verification Form (V5)
financial.aid@nau.edu 855-628-6333 PO Box 4108, Flagstaff, AZ 86011 nau.edu/osfa A. Student Information Student Name: Phone: 2019-2020 Sage Verification Form (V5) 7-digit NAU ID Number: NAU E-mail: Your
More information6707 E 12th St Tulsa, OK Phone: Fax:
6707 E 12th St Tulsa, OK 74112 Phone: 866-529-8369 Fax: 866-950-7248 shawn.lay@lei-corp.com I hereby authorize my credit card company to make my application fee to LEI Properties LLC by charging the fee
More informationDISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:
DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT Company Name: In connection with your application and/or employment with above listed Company (hereinafter the Company ) this
More informationService Retirement Election Application (888) CalPERS ( ) TTY for Speech and Hearing Impaired: (916)
Section 1 Service Retirement Election Application (888) CalPERS (225-7377) TTY for Speech and Hearing Impaired: (916) 795-3240 Please do not mail or deliver your application to CalPERS more than 90 days
More informationBackground Report Dispute
Dear Consumer: In order for us to proceed with the reinvestigation of your dispute you must complete and return the following paperwork along with a clear copy of a government issued photo identification
More informationNAU Police Department s Identity Theft Victim s Packet
NAU Police Department s Identity Theft Victim s Packet Information and Instructions This packet should be completed once you have contacted the NAU Police Department and obtained a police report number
More informationDISCLOSURE OF PROCUREMENT OF CONSUMER REPORT
DISCLOSURE OF PROCUREMENT OF CONSUMER REPORT PLEASE BE ADVISED that UAB - GME Student Residents (the Company ) may obtain information about you from a third-party consumer reporting agency to evaluate
More informationDISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORTS
DISCLOSURE AND AUTHORIZATION 2.1 DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORTS In connection with my application for employment/licensure (including contract or volunteer services) or application to
More informationDIRECT IDENTITY VERIFICATION AND AUTHORIZATION. HISP Name: Orion Health Telephone:
DIRECT IDENTITY VERIFICATION AND AUTHORIZATION Service Provider HISP Name: Orion Health Telephone: +1 800 905 9151 Address: 225 Santa Monica Boulevard, 10th Floor, Santa Monica CA 90401 Account #: 080088
More informationBrunswick Senior Resources, Inc.
BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM In the interest of maintaining the safety and security of our customers, employees, volunteers, and property, Brunswick Senior Resources, Inc. (BSRI)
More informationBACKGROUND CHECK DISCLOSURE & AUTHORIZATION
Organization Name Account DISCLOSURE REGARDING BACKGROUND INVESTIGATION ( the Company ) may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject
More informationINDEPENDENT AGGREGATE VERIFICATION FORM
Office of Financial Aid 2017-2018 INDEPENDENT AGGREGATE VERIFICATION FORM Your 2017-2018 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law
More informationCandidate Disclosure, Authorization & Consent for the Procurement of Consumer Reports
Candidate Disclosure, Authorization & Consent for the Procurement of Consumer Reports Section I: Disclosure (the Company ) may request background information about you from a consumer reporting agency
More informationTEXAS REGIONAL BANK APPLICATION FOR EMPLOYMENT
TEXAS REGIONAL BANK APPLICATION FOR EMPLOYMENT Texas Regional Bank is an equal opportunity employer. All applicants will be considered without regard to race, color, religion, sex, national origin, age,
More informationArbitration Claim INSTRUCTIONS TO CLAIMANT INSTRUCTIONS TO RESPONDENT
For MAA use only: Arbitration Claim Date received: INSTRUCTIONS TO CLAIMANT Case No. To initiate MAA arbitration, please do the following: Complete this Arbitration Claim form, including the Verification
More informationDISCLOSURE OF BACKGROUND INVESTIGATION
DISCLOSURE OF BACKGROUND INVESTIGATION In considering you for employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, discipline, or other
More informationAUTHORIZATION FOR BACKGROUND CHECKS
BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM In the interest of maintaining the safety and security of our customers, employees and property, WNCC-UMC (the Company ) will order a consumer report
More information"SHORT-CUT" Bond Application For contract bonds of $400,000 or less
TOLL-FREE (888) 294-6747 FA (320) 269-3154 erika@goldleafsurety.com CONTRACTOR DATA Fed Tax ID Type of Business: Partnership Company Name (Include DBA) Company Address Type of Work OWNER DATA / INDEMNITORS
More information( ) ( ) Cell Phone Home Phone Address
Last Name First Name M. I. EMPLOYMENT APPLICATION Address City State Zip ( ) ( ) Cell Phone Home Phone E-mail Address Employment Desired Position applying for: Personal Information Have you ever applied
More informationNew American Funding Attn: Loss Draft Department P.O. Box 1064 Tonawanda, NY [DATE]
New American Funding Attn: Loss Draft Department P.O. Box 1064 Tonawanda, NY 14151 [DATE] [NAME1] [NAME2] [MAILING_ADDRESS1] [MAILING_ADDRESS2] [CITY], [STATE] [ZIP] Re: Mortgage Loan No. Property Address:
More informationDisclosure Statement and Authorization
Disclosure Statement In connection with your employment or application for employment with (the Company), the Company may obtain or prepare consumer reports or investigative consumer reports on you to
More informationAPPLICATION FOR EMPLOYMENT ALL REQUESTED INFORMATION MUST BE COMPLETED. PLEASE PRINT IN BLACK INK OR TYPE. PERSONAL INFORMATION
APPLICATION FOR EMPLOYMENT ALL REQUESTED INFORMATION MUST BE COMPLETED. PLEASE PRINT IN BLACK INK OR TYPE. PERSONAL INFORMATION Today s Date Position Applying For Minimum Acceptable Salary Last Name First
More informationIdentity Theft Victim s Packet
Revised April 2010 Identity Theft Victim s Packet Information and Instructions This packet is to be completed once you have contacted the El Paso County Sheriff s Office and obtained a police report number
More informationBACKGROUND CHECK DISCLOSURE & AUTHORIZATION
BACKGROUND CHECK DISCLOSURE & AUTHORIZATION Organization Name Account DISCLOSURE REGARDING BACKGROUND INVESTIGATION ( the Company ) may obtain information about you from a consumer reporting agency for
More information