Source Resources Sign-Up For Services Form

Source Resources sign-ups are limited to:
Law Enforcement, Attorneys, The Insurance Industry, Investigators and Businesses.
Please enter in the information requested below.

Your Name:

Company Name:

Mailing:

Address:

City: State: Zip Code:

Physical (NO P.O. Boxes):

Address:

City: State: Zip Code:

Telephone Numbers:

Voice: Fax:

E-mail Address:

Account Options: * Be sure to choose an account option below. *
Please note that upon choosing the Diamond Discount Plan, A $1000.00 non-refundable charge will be made to you credit card. If you do not want the Diamond Discount Plan, please select General Option below. There are NO SIGN-UP FEES or discounts associated with the General Option.

Billing Information:
The Credit Card below must be a Corporate or Company Card or the Card of the owner, or Officer of the above Company or Corporation.

Method of Payment:

Credit Card Type:

Credit Card Number: Expiration Date: /

Card Holder's Information (As it Appears on the Card):

Name:

Address:
(Where the Monthly Statement is sent)

City: State: Zip Code:

Sign-up Terms:

I understand that I am placing an order or orders for a search of an electronic or mechanical database through a fallible source, and assume full responsibility for inaccurate or incomplete identifying information submitted or results received. I agree that Source Resources is held harmless for errors or omissions, and cannot guarantee the accuracy or completeness of reports for the fee or fees charged. I understand that requests may not be canceled. I certify that all requests are submitted in accordance with FCRA, GLB, DPPA and all other Federal, State, or Local laws that may apply. I authorize the bank or company that issued my credit card to accept this order and future orders with the same authority as if my original signature and card imprint appeared. I also agree that neither SOURCE RESOURCES nor its personnel are responsible for the miss-interpretation of Handwritten Orders. I also understand that prices and availability are subject to change without notice, and that turnaround times are estimated and not guaranteed. I also agree to receive E-Mail and Faxed notification of new and /or special discounts.

Do you Agree with the Terms listed above?

I understand that notices and communications provided to me via email, voicemail, postal address and / or fax machine numbers or addresses will be deemed by Source Resources as having been personally received by me or my company whether actually received or not.