Product & Service Forms

FOR ALL SAMPLE FORMS: Please consult with your legal counsel regarding the proper use of these forms.

Disclosure Forms 

• Disclosure Form - Consumer Report 
• Disclosure Form - Consumer Report - Spanish
• Disclosure Form - Investigative Consumer Report (Suggested Use: Verification of Employment, Education or References)
• Disclosure Form - Investigative Consumer Report - Spanish
• Disclosure Regarding Background Checks Per California Law (Suggested Use: In conjunction with above Disclosures as applicable for those operating or hiring from California)

Acknowledgment & Authorization Forms 

Basic Acknowledgment & Authorization Forms	State & Local Specific Acknowledgment & Authorization Forms
Acknowledgment & Authorization for Background Checks (Basic Acknowledgment & Authorization Form)	California Acknowledgment & Authorization
Acknowledgment & Authorization for Background Checks - Spanish	California Credit History Obtained Acknowledgment & Authorization
European Union Acknowledgment​      (Suggested Use: Requesting International Background Checks from the European Union)	Connecticut Acknowledgment & Authorization
	Los Angeles, California Acknowledgment & Authorization
	Los Angeles, California Credit History Obtained Acknowledgment & Authorization
	Maryland Acknowledgment & Authorization
	Massachusetts Acknowledgment & Authorization
	Minnesota Acknowledgment & Authorization
	New Jersey Acknowledgment & Authorization
	New York State Acknowledgment & Authorization
	New York City, New York Acknowledgment & Authorization
	New York City, New York Credit History Obtained Acknowledgment & Authorization
	Oklahoma Acknowledgment & Authorization
	Oregon Acknowledgment & Authorization
	San Francisco, California Acknowledgment & Authorization
	San Francisco, California Credit History Obtained Acknowledgment & Authorization
	Texas Acknowledgment & Authorization
	Vermont Acknowledgment & Authorization
	Vermont Credit History Obtained Acknowledgment & Authorization
	Washington State Acknowledgment & Authorization

Preliminary Adverse Action Letters — Choose the appropriate Pre-Adverse Action Letter

Basic Pre-Adverse Action Letter	State & Local Specific Pre-Adverse Action Letters
	Arkansas Pre-Adverse Action Letter
Pre-Adverse Action Letter	California Pre-Adverse Action Letter
Pre-Adverse Action Letter - Spanish	Connecticut Pre-Adverse Action Letter
	Colorado Pre-Adverse Action Letter
	Delaware Pre-Adverse Action Letter
	Los Angeles, California Pre-Adverse Action Letter
	Illinois Pre-Adverse Action Letter
	Maryland Pre-Adverse Action Letter
	Maryland Counties (Montgomery/Prince George) Pre-Adverse Action Letter
	Massachusetts Pre-Adverse Action Letter
	New Hampshire Pre-Adverse Action Letter
	North Carolina Pre-Adverse Action Letter
	North Dakota Pre-Adverse Action Letter
	New Jersey Pre-Adverse Action Letter
	New York City, New York Pre-Adverse Action Letter
	New York State Pre-Adverse Action Letter
	OklahoOKLAHOMA-PRE-ADVERSE-ACTION-LETTERma Pre-Adverse Action Letter
	Philadelphia, Pennsylvania Pre-Adverse Action Letter
	Puerto Rico Pre-Adverse Action Letter
	Rhode Island Pre-Adverse Action Letter
	San Francisco, California Pre-Adverse Action Letter
	Seattle, Washington Pre-Adverse Action Letter
	Texas State Pre-Adverse Action Letter
	Washington State Pre-Adverse Action Letter
	West Virginia Pre-Adverse Action Letter

Post Adverse Action Letters — Choose the appropriate Adverse Action Letter

Basic Adverse Action Letter	State & Local Specific Adverse Action Letters
Adverse Action Letter	Arkansas Adverse Action Letter
Advese Action Letter - Spanish	Austin, Texas Adverse Action Letter
	California Adverse Action Letter
	Chicago, Illinois Adverse Action Letter
	Colorado Adverse Action Letter
	Connecticut Adverse Action Letter
	Delaware Adverse Action Letter
	Illinois Adverse Action Letter
	Los Angeles, California Adverse Action Letter
	Maryland Adverse Action Letter
	Maryland Counties (Montgomery/Prince George) Adverse Action Letter
	Massachusetts Adverse Action Letter
	New Hampshire Adverse Action Letter
	New Jersey Adverse Action Letter
	New York City, New York Adverse Action Letter
	New York State Adverse Action Letter
	North Carolina Adverse Action Letter
	North Dakota Adverse Action Letter
	Oklahoma Adverse Action Letter
	Philadelphia, Pennsylvania Adverse Action Letter
	Portland, Oregon Adverse Action Letter
	Puerto Rico Adverse Action Letter
	Rhode Island Adverse Action Letter
	San Francisco, California Adverse Action Letter
	Seattle, Washington Adverse Action Letter
	Texas Adverse Action Letter
	West Virgina Adverse Action Letter

FCRA Compliance Forms

Summary of Consumer Rights	Reinvestigation Request Form
Resumen de Derechos	Solicitud de Reinvestigacion
Identity Theft Notice	Copy Request Form
Remediando los Efectos del Robo de Identidad	Solicitud de Copia
Notice to Furnishers of Information	FCRA Quick Reference Guide
Notice to Users of Consumer Reports	Security Freeze Notice

Consent-Based SSN Verification (CBSV)

• Consent Based SSN Verification (CBSV)  
• Consent Based SSN Verification (CBSV) - Spanish Version
• CBSV Addendum to Service Agreement (PDF) 
• CBSV Printed Signature Acknowledgment 
• CBSV Form SSA-89 Instructions 

Pre-Employment Screening Credit Reports
To order credit products for Pre-Employment Screening, please complete the following forms:

• Membership Application 
• PEER Service Agreement 
• Letter of Intent 
• Verification Authorization
• Membership Profile Form (Updates Only) 

Tenant Screening Credit Reports
To order credit products for Pre-Tenant or Franchisee Screening, please complete the following forms:

• Membership Application 
• CREDIT Service Agreement 
• Letter of Intent 
• Verification Authorization
• Membership Profile Form (Updates Only) 

EVAL (Electronic Validation of Applicant Legitimacy)

• Electronic Validation Matrix
• Electronic Validation HR Support Service Addendum

I-9 / E-Verify

• Client Registration Form

Medical Fraud & Abuse Information

• Source Summary

International Searches
To order International searches you must complete a form for each type of search you are requesting (Criminal, Employment Verification, Education Verification). A copy of a diploma is required for education verifications. Please return the forms with the signed release to International@intellicorp.net or via fax: 216-450-5233.

• International Criminal Search Request Form 
• International Education Verification Search Request Form 
• International Employment Verification Search Request Form

Motor Vehicle Records

To order Motor Vehicle Reports from the following states, you must file a state agreement. Click on any of the state links below to access the forms you need.

• Pennsylvania Employment Agreement 
• Pennsylvania Insurance Agreement 

Certain states have rules in place related to the use of electronic signatures as part of Disclosure to and obtaining Authorization from the consumer when ordering Motor Vehicle Reports. Click here for an overview of which states may have requirements related to “wet” signatures when ordering Motor Vehicle Reports.

Please contact our Client Success Team between the hours of 8:00 AM and 6:00 PM ET for general questions regarding motor vehicle record access via phone (888-946-8355) or email (customerservice@intellicorp.net).

MVR State Specific Releases*

*Washington State Release retained by your company after obtaining driver’s consent. Unless requested, do not send to IntelliCorp.

Puerto Rico Authorization Release of Driving Record

*Puerto Rico Authorization Release must be submitted to IntelliCorp via MVR Compliance.

Service Agreements

• Medical Fraud and Abuse Information Service Agreement 
• National Practitioner Data Bank Service Agreement 
• Non-FCRA Permissible Purpose Access Service Agreement 
• IntelliCorp Service Agreement 
• Non-Disclosure Agreement

Account Information Change Form

• Account Information Change Form 

Other Documentation

• New York Article 23-A
• Georgia Background Check Consent Form