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| Licenses: A9200376 | ||
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CREDIT CARD AUTHORIZATION |
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| Carol Sciannameo Investigations Inc. dba Tampa Bay Investigations, and/or its banking vendors, is authorized by my signature below to charge the credit card listed below for Investigative Services. | ||
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I authorize the initial payment in the form of a retainer for the amount of $___________ |
| Name on credit card ______________________ _____ ______________________ | ||
| First Name Initial Last Name |
| Billing Address __________________________________________________________ | ||
| City_________________________ State ________________ Zip code __________ |
| Credit Card Number ___________ _________ _________ ____________ | ||
| Expiration Date _______ / ________ Security # _____ (last 3 or 4 digits on back of card) |
| Circle One: Visa / Master Card / American Express / Discover | ||
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| I understand the amount of the retainer is the amount required for any work to be performed. The retainer amount is not the final invoice or sale amount for the services. The retainer is an estimate for requested investigative services. | ||
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| Tampa Bay Investigations will not exceed a limit of $_________, without written authorization. Note: (This amount cannot be less than$200.00 more than retainer, example: If the retainer is $1000.00, then the limit should be $1200.00) | ||
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| Client acknowledges that the credit card charges will be processed by PayPal, Inc. Client also gives Carol Sciannameo Investigations, Inc. dba Tampa Bay Investigations and / or its employees the right to process the above credit card payment online through PayPal. A payment receipt can be provided via e-mail directly from PayPal. | ||
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| I understand that any unauthorized signature on this document, or any attempt for any reason to circumvent the payment of the credit card, constitutes forgery and/or fraud, subject to penalties of the law. | ||
| ____________________________ ________________________________ | ||
| Print Name Signature | ||
| ( ) Check if you want a receipt E-mail Address for payment receipt ________________________________ | ||
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FAX THIS FORM TO: 727-321-9530 |
