Investigative Services - phonebust.com
CREDIT CARD AUTHORIZATION & VALIDATION FORM
PLEASE PRINT CLEARLY!!!
form is used to prevent credit card fraud. It is for your protection and
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 phonebust.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.)
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:___________
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
871 Thornton Parkway, Suite 140,
Thornton, CO 80229
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