PO Box 862, Galax VA 24333
The below listed Person/Company hereafter known as the Client, understands that all information provided through use of the system carries no
representations,either actual or implied, as to the accuracy, timeliness, currents, merchant ability or fitness for a particular purpose of the information
provided. The Client further holds harmless the officers, directors, employees, and agents of DTO / Data-Trac against any and all direct or indirect losses,
claims, demands, expenses, or liabilities of whatever nature or kind arising out of the Client's use or misuse of the information provided. The Client further
acknowledges that the use of the system is at the Client's own risk. DTO / Data-Trac, it's officers, directors, employees, and agents assume no
responsibility or liability for the Client's misuse of the system or for any damage, information loss, system failure, etc. which may result from the Client's use
of the system. The Client agrees, both jointly and severally, to maintain all required minimum account balances and pay all fees and charges as agreed upon.
The Client acknowledges that the signature affixed hereto whether original or facsimile, will serve as a binding instrument on behalf of the Person/Company
listed below. The client is responsible for checking and following state and federal laws as it may apply to his or her State or Jurisdiction as to the information
provided on this system.The Client understands that all information is provided in strict compliance with the Fair Credit Reporting Act.
Under no circumstances do we allow our system to be utilized for background reports on any Celebrities, Politicians or Public figures for any reason.
| Business Name: |
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| Business Address: |
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City/State/Zip: |
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| Phone Number: |
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| Fax Number: |
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| Customer Name: |
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| Home Address: |
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City/State/Zip: |
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| Driver License No. and State: |
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| Email Address: |
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| Customer Signature: |
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