The Agent Prequalification Form serves as a vital tool in the process of establishing a business relationship with service providers, ensuring that all potential agents meet a certain standard before engaging in professional activities. This comprehensive form covers a wide range of informational requests, starting from basic queries such as the name and address of the business, to more detailed scrutiny including incorporation status, proof of licenses, and the business's Federal Employer Identification Number (FEIN) or Tax ID Number. Furthermore, it delves into the personal backgrounds of major partners, including their Social Security numbers and residential statuses, demanding a high level of transparency. Additionally, the form inquires whether the business operates under a different name than its incorporation license and if it has officially registered any alternate trade names for commercial purposes. Financial stability and integrity are also key areas of focus, with questions about previous bankruptcy declarations and the requirement to list business and personal bank accounts. References are another crucial aspect, ensuring a third-party verification of the business’s reliability. The form is clear in its intention to provide a thorough background check and credit inquiry as part of its prequalification process. With its comprehensive approach, the form encapsulates a critical step towards securing a formal and trustworthy agency agreement.
| Question | Answer |
|---|---|
| Form Name | Agent Prequalification Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | unitransfer login, unitransfer app, undersigned, Unitransfer |
AGENT
1‐ What is the Name of your Business?
|
________________________________________________________________ |
||
2‐ |
Business Address? |
|
|
|
________________________________________________________________ |
||
|
City:_______________________ State:____________ |
Zip Code:_________ |
|
|
Telephones: ________________________________ Fax:__________________ |
||
|
Email Address: ___________________________________________________ |
||
3‐ |
Has your business been Incorporated (INC)? |
Yes___ |
No___ |
4‐ What is the Name appearing on your Incorporation License?
_______________________________________________________________
Please provide proof (copy of License)
Services provided?
___________________________________________________
5‐ Business Federal Employer Identification Number (FEIN) or Tax Id. Number?
_______________________________________________________________
Please provide proof (copy of License)
6‐ Social Security Number(s) of the major partners?
1.Last Name:______________________First Name:____________________
Alien Card #________________________Driver’s lic #_____________________
SSN___ ___ ___‐ ___ ___ ‐ ___ ___ ___ ___
RESIDENTIAL ADDRESS:_________________________________________________
Phone:_________________________Cell:__________________________
Rent:___________ Own:___________
2.Last Name:______________________First Name:____________________
Alien Card #_____________________Driver’s lic #________________________
SSN__ ___ ___ ‐ ___ ___ ‐ ___ ___ ___ ___
RESIDENTIAL ADDRESS:_________________________________________________
Revised August 2010
Internet Submission
Agent
Fax No. 1 (800)
Phone:__________________________Cell:__________________________
Rent:___________ Own:___________
7‐ Is the name shown on your Incorporation license different from that under which you do business?
Yes____No____
8‐ Has the name under which you do business (make advertisement, flyers, radio spots, TV ad etc.) been registered as a DBA (Doing Business As)?
Yes:____No:____
If registered, please provide proof (copy of Registration).
9‐ Have you ever declared bankruptcy?Yes:____No:____
If Yes, Date:______________________
Please list the Business and Partner’s personal bank accounts:
1.‐ Bank:________________________ acc#_________________________________
2.‐ Bank:________________________ acc#_________________________________
3.‐ Bank:________________________ acc#_________________________________
REFERENCES: (2 NAMES)
1.‐ NAME:____________________________________PHONE__________________
ADDRESS:____________________________________________________________
2.‐ NAME:____________________________________PHONE__________________
ADDRESS:____________________________________________________________
NOTA BENE
The above information being asked of you is required by your State Financial Regulators. The undersigned acknowledge that the above is true and correct and hereby authorize Unitransfer to use any legal means to corroborate them. They understand this questionnaire will be used for credit inquiry and background check. If the application is approved, they hereby authorize Unitransfer to perform periodic credit and background checks.
If you have any questions, please contact the Management Department at 1‐877‐864‐8726.
Signature: (1)________________________________ |
Date:______________ |
Signature: (2)________________________________ |
Date:______________ |
This instrument has been signed before me on the ……. day of …………. 20…. By…………………....
………………………………….who presented …………………………………..as
identification or is personally known to me.
____________________________
Notary Name, Seal and Signature
Revised August 2010
Internet Submission
Agent
Fax No. 1 (800)