Legal Consumer Consent Form

LEGAL CONSUMER CONSENT FORM

This Legal Consumer Consent Form (the "Consent") is entered into as of Effective Date: by and between Company Name: , Address: ("Company"), and Consumer Name: , Address: ("Consumer").

Recitals

WHEREAS, Consumer has requested that Company provide certain products, services or determinations that require the collection, use or verification of Consumer's personal information; and

WHEREAS, Company requires the Consumer's informed, written consent to obtain, use, disclose, or retain specified personal information for the purposes set forth herein; and

WHEREAS, Consumer is willing to grant such consent subject to the terms, limitations and disclosures set forth in this Consent.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. Authorization to Collect and Use Personal Information

Consumer expressly authorizes Company and its agents, contractors and affiliates to collect, access, use and process Consumer's personal information, including but not limited to name, address, date of birth, government identification numbers, employment information, financial account information, consumer report information and transaction history (collectively, "Personal Information"), for the purposes of evaluating eligibility for products or services, performing account administration, verifying identity, preventing fraud, and complying with legal obligations. The scope of the authorization includes information obtained directly from Consumer and information obtained from third-party sources, subject to the limitations in this Consent.

2. Consumer Representations; Data Provided

Consumer represents and warrants that the Personal Information provided to Company is true, complete and accurate. Consumer provides the following information for the purpose of identification and verification:

3. Consent to Consumer Reports and Background Checks

Consumer authorizes Company and its agents to obtain consumer reports, investigative consumer reports, credit reports, criminal background checks, motor vehicle records and other third-party reports (collectively, "Consumer Reports") as reasonably necessary to evaluate Consumer's application, request for services or continued eligibility. Consumer acknowledges that such Consumer Reports may be used in whole or in part in making decisions regarding provision of services. Consumer further acknowledges that Consumer has received any required pre-adverse action disclosures where applicable and will receive required notices in the event adverse action is taken based in whole or in part on a Consumer Report.

Consumer's authorization under this Section is valid for a period of from the Effective Date unless earlier revoked pursuant to Section 6 below.

4. Electronic Communications and Signatures

Consumer consents to receive communications, notices and disclosures electronically, including by email, text message, or other electronic means. Consumer's preferred email for electronic communications: . Consumer's preferred mobile number for SMS: .

Consumer agrees that electronic signatures and electronic records shall be of the same legal effect as handwritten signatures and paper records, to the fullest extent permitted by applicable law.

5. Disclosure to Third Parties

Consumer acknowledges and agrees that Company may disclose Personal Information and Consumer Reports to third parties, including service providers, affiliates, credit bureaus, insurers, collection agents and governmental authorities when required by law. Company shall require recipients to maintain appropriate confidentiality and data security measures consistent with Company's legal obligations. Notwithstanding the foregoing, Company shall have no liability for unauthorized disclosures caused by third parties beyond Company's reasonable control.

6. Revocation of Consent

Consumer may revoke this Consent at any time by delivering a signed written notice to Company's notice address specified below. Revocation shall be effective upon Company's receipt of such written notice. Revocation will not apply retroactively to information already collected or to processing based on this Consent before receipt of the revocation, and may affect Consumer's ability to obtain or retain services.

7. Data Security; Retention

Company shall maintain reasonable administrative, technical and physical safeguards to protect Personal Information against unauthorized access, disclosure, alteration or destruction. Company may retain Personal Information for as long as necessary to fulfill the purposes described in this Consent, to comply with legal obligations, resolve disputes, and enforce agreements.

8. Fees and Payment Authorization (If Applicable)

If a fee is required for obtaining Consumer Reports or other services, Consumer authorizes Company to charge Consumer's payment method as agreed. Consumer may indicate a payment authorization below where applicable.

9. Governing Law; Venue

This Consent shall be governed by and construed in accordance with the laws of the state identified below without regard to that state's conflicts of law principles. The parties submit to the exclusive jurisdiction of the courts located in the county entered below for any action arising out of or relating to this Consent.

10. Entire Agreement; Severability; Amendments; Waiver; Counterparts; Notices

This Consent constitutes the entire agreement between the parties concerning its subject matter and supersedes all prior understandings and agreements. If any provision is held invalid or unenforceable, the remaining provisions shall continue in full force and effect. This Consent may be amended only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party against whom enforcement is sought. This Consent may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Notices required under this Consent shall be given in writing and delivered to the addresses provided in the opening paragraph or other address provided in writing pursuant to the notice provisions.

11. Certification

By signing below, Consumer certifies under penalty of perjury that the information provided in this Consent is true, accurate and complete to the best of Consumer's knowledge, and that Consumer has read, understands and agrees to the terms and conditions set forth herein.

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