United Software Developers Inc.

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Please complete the form below. Form data will be validated after completion and by clicking on the 'Print Application' button.

Please, print the application, sign and fax it to:

ATTN: Helen Gelb, United Software Developers, Inc.
FAX# (718) 648-9470

You may also mail your application to:

United Software Developers, Inc.
ATTN: Helen Gelb
2913 Avenue V
Brooklyn, New York 11229

Please include your check payable to United Software Developers, Inc. A minimum deposit of $200 is required to signup for a MVR Account. This amount will be applied to your account. DO NOT MAIL YOUR CHECK.

MVR CORPORATE ACCOUNT REQUEST FORM

GENERAL INFORMATION	Please complete all

Company Name
Address
City
State
Zip
Phone
Fax
E-Mail Address
Contact Person
What USER NAME would you like to use? (4 - 10 characters please)
What PASSWORD would you like to use? (4 - 10 characters please)
How did you hear about us?

BUSINESS TYPE	Please select one

Insurance Agency (MGA, Broker)
Insurance Company
Other (please describe)

PAYMENT INFORMATION	Please complete all

Full Bank Name
Bank Address
Bank Routing Number
Account Number
Check Number
Amount for Account Deposit	$ minimum $200 required
Please Choose Your Payment Option	AUTOMATED ACCOUNT (Preferred Option) A minimum deposit of $200 (optional $500 or $1,000) is required for your escrow account. When your account balance is $50 or less, the system will automatically generate a draft from your account in the amount of $200 (optional $500 or $1,000), update your escrow account and send you an e-mail confirmation along with a copy of the draft for your records. It will take 2 - 3 days before the deposit shows on your account, but the money will be available immediately in your escrow account to run MVRs. Please select your escrow account minimum: 200 500 1000 WATCH YOUR OWN ACCOUNT If you choose to watch your own account, you have the following payment options: 1) Online Payment. Link: http://www.usdsoftware.com/pay_usd (Payment is credited instantly) 2) Check by Phone Payment. Call (718) 648-5300 ext. 204 (Payment is credited instantly) 3) Check by Fax Payment (Payment is credited instantly during business hours 9 AM - 5 PM, Monday-Friday) Please note that watching your own account means that if you run out of money in your escrow account and don't submit a payment, you wont be able to run MVRs until you make a payment

WE ORDER MVRs FOR THE PURPOSE OF	Select all that apply.

Underwriting an insurance policy	You are the recipient

Accounts must have a permissible purpose to order MVRs. Permissible use is stated as follows:

FCRA section number (§§ 604. Permissible purposes of consumer reports [15 U.S.C. § 1681b])
(a) In general. Subject to subsection (c), any consumer reporting agency may furnish a consumer report under the following circumstances and no other:

(1) In response to the order of a court having jurisdiction to issue such an order, or a subpoena issued in connection with proceedings before a Federal grand jury.

(2) In accordance with the written instructions of the consumer to whom it relates.

(3) To a person which it has reason to believe

(A) intends to use the information in connection with a credit transaction involving the consumer on whom the information is to be furnished and involving the extension of credit to, or review or collection of an account of, the consumer; or

(B) intends to use the information for employment purposes; or

(D) intends to use the information in connection with a determination of the consumer's eligibility for a license or other benefit granted by a governmental instrumentality required by law to consider an applicant's financial responsibility or status; or

(E) intends to use the information, as a potential investor or servicer, or current insurer, in connection with a valuation of, or an assessment of the credit or prepayment risks associated with, an existing credit obligation; or

(F) otherwise has a legitimate business need for the information

(i) in connection with a business transaction that is initiated by the consumer; or

(ii) to review an account to determine whether the consumer continues to meet the terms of the account.

(4) In response to a request by the head of a State or local child support enforcement agency (or a State or local government official authorized by the head of such an agency), if the person making the request certifies to the consumer reporting agency that

(A) the consumer report is needed for the purpose of establishing an individual's capacity to make child support payments or determining the appropriate level of such payments;
: (B) the paternity of the consumer for the child to which the obligation relates has been established or acknowledged by the consumer in accordance with State laws under which the obligation arises (if required by those laws);
: (C) the person has provided at least 10 days' prior notice to the consumer whose report is requested, by certified or registered mail to the last known address of the consumer, that the report will be requested; and
: (D) the consumer report will be kept confidential, will be used solely for a purpose described in subparagraph (A), and will not be used in connection with any other civil, administrative, or criminal proceeding, or for any other purpose.

(5) To an agency administering a State plan under Section 454 of the Social Security Act (42 U.S.C. § 654) for use to set an initial or modified child support award

Click here to read the entire Fair Credit Reporting Act: http://www.ftc.gov/os/statutes/fcra.htm

I have read and understand the above F.C.R.A. statement and I/we are in compliance with the Fair Credit Reporting Act (FCRA), 15 U.S.C. § 1681 et seq.

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