Subscriber Agreement
Employee Locator Customer Information Form and Service Agreement
   
Company Name:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
Email:
Contact Person:
Type of Business:
Parent Company (If applicable):
Years in Business:
# of Employees:
State of Incorporation/LLC/LP/PC:
Year Incorporated:
   
Credit Card Information:  
Credit Card Type*
Name on Card
Credit Card Number
Credit Card Expiration Date
Card Billing Address
Number & Street
City
State/Province
Zip/Postal Code
Country:
3-Digit Security Code (AMEX is 4-digit)
   
How did you hear about us?
   
Please create your account name by using the first 12 letters of your company name, all caps, no punctuation marks, no spaces. For example, if your company is Pension Benefits Inc., you could use PENSIONBEN. Please write your account name down and keep it in a safe place for future reference. If we find an overlap, we will modify your user name and let you know by e-mail. Once completed you may click the button at the top of this page for existing clients to order - no need to wait!
   
Account Name:
   

To establish a new account we must safeguard the privacy of your missing plan participants by strict compliance with the Dodd-Frank Act, Gramm-Leach-Bliley Act and HIPAA end-user transparency requirements.

If you are a sole proprietor, please upload a copy of your active business license or your driver's license here. For corporations, please upload your active business license or articles of incorporation.

Once you complete and sign the form on this page, upload the appropriate documents, and click send, you are ready to order (just click on Order Now).

We will process your order concurrent to opening your account usually in about 24-48 hours and send the results to you in a secure email with the social security numbers truncated; per Federal Privacy Laws. We look forward to serving you soon!

If you are unfamiliar with the Fair Credit Reporting Act, go to www.FTC.com for further information.
   

AGREEMENT: I/We understand that EMPLOYEELOCATOR.COM is a "commercial locator service" as defined in 946 29 CFR Ch. XL (7–1–07 Edition) namely: Code of Federal Regulations, Title 29 - Labor, Part 4050.4, Paragraph (b) (3) [commonly known as 29 CFR 4050.4 {etal}] in the business of locating lost: employees, retirement plan participants, pension plan beneficiaries, and/or current addresses for accuracy in income reporting purposes under IRS forms 1099 and/or W-2 and as supplementally defined by 29 CFR Part 516 to: (and I/We certify that we are members of); one or more of these qualified end-user categories: employers, third-party pension plan administrators (TPA), advisors, actuaries, distributors, plan maintenance organizations (PMO); Human Resources Departments/Benefits & Pension Plan Managers; Licensed Attorneys, IRS Enrolled Agents and Certified Public Accountants in the business of providing advice, administration services, consultation and other services strictly within the context of pension and benefit administration.

I/We acknowledge and agree that EMPLOYEELOCATOR.COM is not a "consumer reporting agency," as defined by U.S.C. 1681 Fair Credit Reporting Act (FCRA), and that the EMPLOYEELOCATOR.COM locator reports do not constitute a "consumer report," as defined by, the FCRA and accordingly, are not subject to the FCRA requirements relating to disputes, access, accuracy or otherwise.

I/We further acknowledge and agree that the EMPLOYEELOCATOR.COM data provided, accessed, received and/or obtained hereunder shall not be used in whole or in part as a factor in determining eligibility for credit, insurance, or employment or for any other purpose contemplated by the FCRA.

I/We understand that we are considered an "End-User" under the law, are a member of the list of qualified subscribers, defined above and for no other purpose.

I/We certify our purpose(s) for using EMPLOYEELOCATOR.COM services as:

  1. For use solely in conjunction with a legal or beneficial interest held by me/us and relating to the Consumer
  2. For use solely in my/our fiduciary or representative capacity on behalf of the Consumer;
and that I/We shall use EMPLOYEELOCATOR.COM services solely for my/our one-time use and that I/We shall hold same in strict confidence.
I/We shall not request, obtain or re-distribute EMPLOYEELOCATOR.COM services for any other purpose, including but not limited to, for the purpose of selling, leasing, renting or otherwise providing information obtained under this agreement to any other party whether alone, in conjunction with my/our data or otherwise in any service which is derived from EMPLOYEELOCATOR.COM services.
I/We understand that EMPLOYEELOCATOR.COM services shall be requested by and disclosed by me/us only to my/our designated and authorized employees having a need to know and only to the extent necessary to enable me/us to use the services in accordance with this agreement.
I/We shall ensure that such designated and authorized employees shall not attempt to obtain any EMPLOYEELOCATOR.COM services on themselves, associates, family members, friends or any other person including celebrities, persons in the news, politicians, government officials, sworn law enforcement officers, agents or officers of the court or others in the public eye except in the exercise of my/our official duties.

I/We agree to maintain copies of any and all written authorizations and or documents authorizing access to this service or which otherwise verifies the existence of the fiduciary relationship identified above for a minimum of five(5) years from the date of inquiry. With just cause, such as violation of any of the terms of this Agreement or any legal requirement or a material change in existing legal requirements that may adversely affect this agreement, I/We understand that EMPLOYEELOCATOR.COM may discontinue service and cancel this agreement immediately.

I/We understand that information contained in EMPLOYEELOCATOR.COM's reports may contain information from the U.S. National Technical Information Service (NTIS) more commonly known as the Social Security Administrations' Death Master File (SSA/DMF) and hereby certify that we are an authorized end-user of said information identified under 15 CFR 1110.2 (a) (ii); and further certify security compliance with 15 CFR 1110.2 (b) a law which also includes penalties for non-compliance under 15 CFR 1110.200 for which we are subject to; and that EMPLOYEELOCATOR.COM has directed us to: ecfr.gov for further understanding of these statutes.

I/We agree to use EMPLOYEELOCATOR.COM services ONLY under the above conditions and, specifically ONLY to locate missing employees, pension plan participants, or those whom I/We hold a beneficial interest on behalf of; AND FOR NO OTHER REASON, and agree that we are the END-USER of the information and will not sell, transfer or otherwise convey the information contained within the EMPLOYEELOCATOR.COM report to any non-interested party and if otherwise conveyed, only to those who may be involved in the process of oversight and/or management of the benefit due to the party sought.

I/We acknowledge that the most important part of this agreement is compliance with applicable statutes governing the use, maintenance and security of the Consumer's Personally Identifiable Information (PII), namely the Gramm-Leach-Bliley Act (15 U.S.C. ss 6801-6809) (GLBA)and that all good faith efforts will be employed to comply with the law, and to protect the privacy of the Consumer, including but not limited to maintaining all associated consents, reports, files, documents, and communications associated herewith in a confidential and secure manner. I/We acknowledge that EMPLOYEELOCATOR.COM has directed us to the Federal Trade Commission's website at www.ftc.gov for further review of any of these statutes so that I/We may enter into this agreement with complete understanding of the applicable privacy and reporting laws governing EMPLOYEELOCATOR.COM services.

I/We also agree to any and all pass-through audit procedures required by law, or any service agreements with EMPLOYEELOCATOR.COM vendors.

I/We fully indemnify and hold EMPLOYEELOCATOR.COM its vendors, heirs, assigns, or any other interested party associated in any capacity with EMPLOYEELOCATOR.COM harmless for any direct, indirect, consequential or other damages as relates to our requests for and/or use of these services from EMPLOYEELOCATOR.COM, et al.

Further, I/We agree to pay for all charges incurred for requested services, and agree to pay all collection costs associated with any collection attempt made by EMPLOYEELOCATOR.COM necessitated by our failure to pay for applicable charges in a timely manner.

Additionally, I/We understand that EMPLOYEELOCATOR.COM is a proprietary business, and that its forms, procedures, policies, methods and reports are confidential, and for the exclusive use by our subscribers only and thus agree not to disseminate same to any unauthorized third parties without expressed written consent from EMPLOYEELOCATOR.COM.

Finally, I/We understand that because of the highly fluid nature of Consumer Privacy compliance, EMPLOYEELOCATOR.COM reserves the right to modify any applicable statutory components of this agreement as may become necessary with reasonable notice and that as an END USER I/We will maintain compliance with any changes in applicable statutes in order to remain compliant with all applicable laws governing EMPLOYEELOCATOR.COM's existence in so far as EMPLOYEELOCATOR.COM's ability to deliver said reports are concerned. In this regard, I/We understand that EMPLOYEELOCATOR.COM has no intention of changing the nature of the business relationship set forth herein, only where compliance changes may become necessary with regard to implementation of statutory provisions and which may change the complexion of the Use and Reporting of the PII, in keeping with strict adherence to applicable Privacy Statutes and for the ultimate protection of the consumers upon whom these reports are provided.

   
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Please do not hesitate to call us if you have any questions about locating missing benefit plan participants.
We are here to serve you!