Date: 

 TO:     Credit Bureau Services, Inc.           Fax: 954-567-1441 OR Email to:  info@credit1400.com

COMPANY NAME: __________________________________________________________
                                  (The company you have YOUR license with)

I am requesting a login for TENANT SCREENINGThis is for tenant screening purposes ONLY.  I will not pull credit reports for any other purpose.

  Name: _________________________________________________________

  Street: _________________________________________________________

  City, State & Zip :  ________________________________________________

  Home Telephone: ________________________________________________

  Office Telephone:   ________________________________________________

  Cell Phone: _____________________________________________________

  Fax: __________________________________________________________

  Social Security No:  ______________________________________________

 Email: _________________________________________

 

  X

Signature and Date  

Please fax this form to 954-567-1441 OR email to:  info@credit1400.com along with a legible copy of your driver's license or other acceptable form of photo ID.  If you do not provide an ID, your application will not be processed.  All agents are set up for credit card payment ONLY.

Thank you!  We appreciate your business!

3503 N. Dixie Hwy, Oakland Park, FL  33334

954-561-1400            FAX:  954-567-1441

EMAIL:  INFO@CREDIT1400.COM