Advanced Investigative & Screening Solutions
6046 FM 2920 #103
Spring, Tx 77379
Phone: 281-397-9535 Fax: 281-895-9968
State of Texas License #A08817
E-mail: info@houstonpi.com
www.houstonpi.com

Credit Card Authorization

Name:____________________________________________

Address: ___________________________________________city/state/zip________________

Phone#:____________________________________________

Account Type: (check one)

Individual _________
Business __________

Authorizing Agent: ______________________; Title: _________________________________

Credit Card Information

Name as it appears on card: ______________________________________________________________

Type of card (VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS): __________________________________________

Credit Card #: _________________________________________________________________________

Expiration Date: ______________/______________/______________

On the back of your card, in the signature block, your credit card# is followed by 3 numbers- they are: ________

AMOUNT: $________________________________

Texas residents add 7.25% TAX: _________________

TOTAL: $______________________________

**Charge will appear on card as "A.I.S.S."**

I authorize Advanced Investigative & Screening Solutions, Scott Baldwin as Agent, to process a charge on the above account, for deposit into the agency account and credit any outstanding invoices, as follows:

* For a single payment in full of an invoice.
* Open Balances thirty days or more past due will be AUTOMATICALLY drafted and deposited for payment in full.

Your credit card will be verified with the bank prior to commencement of your request and the release of any information.