User Application

Documents Checklist

Required Documents Checklist:

  • (see sample)

* Onsite physical inspection is required for all new applications and any relocation there after except for FDIC, NCUA, or publicly traded companies.

Confidential

The information contained in and following this document is intended only for the use of the addressee and may contain information that is confidential, privileged, and/or otherwise exempt from disclosure under applicable law. If you are not the intended recipient or the employee or agent responsible for delivering the transmittal to the intended recipient, you are not authorized to read the transmittal and are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. This transmission is not intended to waive the confidential and/or proprietary nature of the information contained herein, or any other confidential or privileged relationship. If you have received this communication in error, please notify us immediately by telephone 800-352-5882 and return the original message to us immediately at the above address.

Please list your CIC Credit Account Representative.*

Customer Profile(Required)
Contact Information(Required)

Primary Contact

Compliance Contact (individual we can contact for additional information as needed to complete the sign-up process)

Billing Contact

Business Information(Required)

(Please attach a copy of your business license including DBA or Proof of Affiliation as applicable)

Does the company currently resell or intend to resell information from the consumer credit report?

Business Banking Reference

(in lieu of voided business banking check)

Attach a voided check
Business Reference(Required)

i.e., Closing Attorney, Realtor, Lender, Other Business Relationship

Current Credit Vendor Reference
Officers, Owners, Partners, Members or Managing Partners(Required)

Persons listed below must be company officers/owners, (i.e. CEO, President, Vice President, CFO, General Manager, etc.) who are duly authorized to bind the company and extended contract coverage to any locations added in the future. If company is limited liability company, managers may sign. Please include additional principal names and titles if applicable.

Attachment files



* (see sample)
Permissible purpose

As a CIC Client you certify that your permissible purpose for ordering consumer credit reports (“Report”) is (select all that apply):

THE FCRA PROVIDES THAT ANY PERSON WHO KNOWINGLY AND WILLFULLY OBTAINS INFORMATION ON A CONSUMER FROM A CONSUMER REPORTING AGENCY UNDER FALSE PRETENSES SHALL BE FINED UNDER TITLE 18, UNITED STATES CODE, IMPRISONED NOT MORE THAN TWO YEARS, OR BOTH.

The person signing below certifies, represents and warrants that he or she: (1) is duly authorized to bind the Company set forth below, to the terms, conditions and certifications of this Agreement; (2) has direct knowledge of the facts certified in this Agreement; (3) has direct knowledge of the information set forth in the accompanying User Application; and (4) is authorized and hereby consents for User to receive faxes, including, but not limited to telephone and fax advertisements, sent by or on behalf of CIC and its affiliates to the fax number(s) indicated herein. The person signing below also authorizes User’s creditors to treat a photocopy or facsimile of such person’s signature as if it were an original, and accept such photocopy or facsimile signature as authorization to release credit information to CIC telephonically, or by other secure means. The person below also authorizes CIC to access the individual’s consumer report(s), and applicable business report(s) in connection with this application.

Credit Card Authorization
* Required on all residential accounts

(Required on all Accounts) Please enter the following information exactly as it appears on the credit card.

In the event of default by customer, or if customer does not qualify for standard payment terms, the undersigned authorizes CIC Mortgage Credit, Inc. to charge the credit card set forth below for the total of any and all unpaid invoices.

Credit Card Payment Authorization Agreement

For customers who qualify for standard payment terms but elect to charge invoices to their credit card every month

The undersigned authorizes CIC Mortgage Credit, Inc. to charge the credit card set forth above each month for the balance due from it (the User). A fax copy of this authorization and the undersigned signature may be deemed equivalent to the original and may be used as a duplicate original.

For California, Minnesota or Oklahoma applicants only: If you would like to receive a copy of the consumer report, if one is obtained, please check this box If checked and you are a California applicant, a copy of the consumer report will be sent within three (3) days of the employer receiving a copy of the consumer report.

In compliance with Section 1785.14(a) of the California Civil Code, End User hereby certifies to CIC Credit, Inc. (“CIC Credit”) as follows: (Please check)

End User a retail seller, as defined in Section 1802.3 of the California Civil Code (“Retail Seller”) and issues credit to consumers who appear in person on the basis of applications for credit submitted in person (“Point of Sale”).