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,
P.O. Box 788,
Granbury, TX 76048
Fax: 1-800-297-0012
Copyright 2002, PDJ