BACKGROUND CHECK

(To include Credit Report)

NOTICE AND AUTHORIZATION

(Please print this form and fax it to 401-427-0292)

I, ______________________, hereby consent and authorize Accurate Information Services. and/or its agent to prepare a consumer report including but not limited to obtaining a consumer report and information as to my credit worthiness, credit standing character, general reputation, credit capacity, personal characteristics and mode of living. Public records may be used in this report, such as social security verification, civil and criminal records, liens, judgments, and bankruptcy. In using a consumer report for rental purposes, before taking any adverse action based in whole or in part on the report, the person intending to take such adverse action shall provide to the consumer to whom the report relates, a copy of the report and a description in writing of the rights of the consumer under this title, as prescribed by the Federal Trade Commission section 609 © (3).

_____________________________                                    ________________________

Signature                                                                                Date

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*** Background check cannot be completed unless all areas below are complete***

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Printed Name:____________________________________

Present address________________________________City_____________________

State_____County_______zip code_______number of years at present address____

*If less than 7 years, write previous address in lines below.

D.O.B_________ Social Security #______________ DL State &#_________________

Current place of employment: _____________________________________________

Apartment applying for: __________________________________________________

Explain in the space below any issues with: your Criminal Record, your Social Security# or your Credit History.

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Check this box for credit report