PDJ Investigative Services - pdjservices.com


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