Credit Bureau Services, Inc
Credit Bureau Services, Inc.
PROVIDING CREDIT REPORTS FOR
CONTRACTOR LICENSING
954-561-1400
FAX: 954-567-1441 or email to: info@
APPLICATION FOR BUSINESS CREDIT REPORT FOR LICENSE
Name and address of Licensing Board
Application Number (if known): _______________________
Name of Company to prepare report on
If your company operates as a D/B/A, please state the name of the D/B/A here
Address: Please enter full address. We MUST have a zip code.
Name of Qualifying Contractor on Business Application
Telephone: __________________ Cell: __________________
Email: ___________________
Names of President or Owner name: ______________________________________________
Check one: ______Corporation; _____ LLC; _____ Sole Proprietorship ______Partnership
Federal Tax ID #: ________________________
Report Charge:
$58.00 in Florida
$68.00 Out of State
Fax Number: _________________________________
Credit Card Number: ______________________________ Expiration Date: _______ Three digit security # on back or 4 digit number on front for AMEX ________
Billing Name of Credit Card: ______________________________________
Billing Address of Credit Card: ___________________________________________________
Street address, City, State and zip
Signature: ____________________________________________________________________
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