PDJ Investigative Services - pdjservices.com

CREDIT CARD AUTHORIZATION & VALIDATION FORM
PLEASE PRINT CLEARLY!!!

This form is used to prevent credit card fraud. It is for your protection and for ours.

Please print this form, complete and fax it to us with a photo copy of the front and back of the credit card you are using. Please send it to our fax number (and/or mail to address) below.

In lieu of my credit card imprint, I, ________________________________  (name of cardholder as shown on credit card) agree that I ordered specific services from pdjservices.com. I will honor, and further agree that my credit card was properly charged by PDJ Investigative Services for said services. The credit card used for services was:
___________________     _________________________      ____________
  (Bank credit card name)                       (credit card no.)                                                 (exp. date)

These charges are for services ordered during the month of _____________ in the year _______. The total amount of all services ordered that I am obligated to pay is not to exceed $ _______________ in any given month.

My billing address is: __________________________________________

City: _________________________State: _____  Zip Code:___________

Phone: ________________________ 

I agree not to dispute any charges to my credit card for services properly rendered according to the terms and conditions set forth herein.

Signature of Cardholder: ___________________________________   Date __________

PDJ Services,
871 Thornton Parkway, Suite 140 Thornton, CO 80229

Fax: 1-800-297-0012




Copyright 2002, PDJ