AUTHORIZATION FOR RELEASE OF INFORMATION – CONECTUS WIRELESS

EACH principal/owner owning 20% of Subagent’s company is required to complete this Authorization.

 

TO WHOM IT MAY CONCERN:

I, , am having a confidential background investigation and credit check of me performed by a security firm retained by ConectUS Wireless, in connection with prospective business undertakings. The investigation is being conducted by a security firm retained by ConectUS Wireless.

Therefore, I do hereby authorize a review and full disclosure of all records, or any part thereof, concerning myself or any business enterprise with which I am associated to a security firm retained by ConectUS Wireless, whether said records are public or private, and including those which may be deemed to be of a privileged or confidential nature.

The intention of this authorization is to provide information, which will be utilized as investigative source material. The undersigned releases all persons, including but not limited to, a security firm retained by Verizon Wireless and its agents, and any person or firm which may have retained them to conduct this investigation, from any and all liability which may arise in connection with this investigation or the good faith disclosure of any information by or on behalf of the undersigned or by any individual or firm contacted in connection with this investigation.

Applicant First, Middle and Last Name:

Title:

Date:

Email:

Social Security #:

Date of Birth:  

Home Address:

City/ST/Zip: , ,

Drivers License #: ST: Exp Date:

Home Phone Number:

Mobile Phone Number:

Signature:

*

 

By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent

E-Sign Act Disclosure and Agreement

Your Consent To Use Electronic Records and Electronic Signatures

This website has elected to use electronic signatures as the default choice in lieu of paper. Be advised that according to the U.S. Federal E-SIGN Act in addition to various state laws an electronic signature is legally the same as a paper and ink signature. Also be advised in event enforcement is needed, all signatures are held in trust by SwiftSignature.com, as a neutral 3rd party, and may be legally enforced in court of law as per the terms of your respective contract.

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Electronic Documents for purpose of this disclosure include any documents signed using the Swift Signature service. All documents once signed cannot be revoked or canceled and will be stored for a minimum period of ten (10) years, and are available to either party at any time through our electronic web portal.

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By clicking "Sign and Send" on any document posting to SwiftCloud servers, you are agreeing to the terms contained herein, and are providing your consent to the use of electronic documents and signatures, as well as e-mail or sms phone message delivery of related electronic documents. You are also acknowledging receipt of this disclosure.

Hardware & Software Requirements

Use of this Service Requirements

  1. Connection to the internet
  2. Any internet web browser with graphical interface and a pointing device, aka "a mouse" for desktop computers or a touch screen for tablets or modern phones common after 2004
  3. a PDF reader or browser capable of displaying Adobe PDF documents
  4. A printer, should you wish to print and retain a paper copy of signed documents.

Acknowledgement of your access and consent to electronic records and electronic signature

By clicking "Sign & Send" on any document posting to this service, you agree that

  • You were able to read this E-SIGN Act Disclosure & Agreement
  • Should you desire, you were able to print on paper or electronically save this agreement for future reference
  • You have an active email on file with the owner of this website
  • That the device on which you indicated your agreement or signature, including both your hardware and your software comply with the terms above and were able to render the agreement in a fashion functionally equivalent to paper, and that the document agreed to was both readable and understandable.
  • That any indication of signature and/or initials in addition to information provided is wholly yours and subject to the terms above.
  • You consent to receive electronically any records, notices, agreements or disclosures made to you by our client, the referring service, during the course of your relationship with that company, subject to revocation per terms above.

Electronic Signature         Disclosure & Consent