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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 (or mail) it to us with a photo copy of the front and back of the credit card you are using. Send this completed form to our fax number (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 these charges. My credit card information is:

___________________     _________________________      ____________
  (Bank credit card name)                       (credit card no.)                                                 (exp. date)

The total amount that I am obligated to pay is $ _______________ and authorize PDJ Investigative Services to charge my credit card listed above for these charges.

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 Investigative Services

871 Thornton Parkway, Suite 140 Thornton, CO 80229

Fax: 1-800-297-0012

Copyright 2002, PDJ