As a part of our quick approval and payment protection plan, we require your credit card information. Instead of completing a lengthy Account Application Form, we have created this quick account approval system.

Please read and initial the following clause.

_______ Please invoice and hold the credit card number as a payment guarantee. I also authorize Advanced Investigative & Screening Solutions to charge my credit card 45 days * from the invoice date if payment is not satisfied. I understand that the amount listed on the Invoice reflects a CASH DISCOUNT, and if the Invoice must be satisfied by charging the credit card on file, a 3.5% fee will be added to the total of the Invoice to cover the credit card processing fees.

* AISS requires payment in 30 days, however we give an additional 15 days from the Invoice due date, to allow for any mail delays before your card will be charged.

Credit Card Information: (check your choice)

_____VISA _____MASTERCARD _____DISCOVER_____AMEX

PAYPAL (please call for details)

Credit Card Number: ________________________________ Exp._____ / ______

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

Name On Card: _________________________________

Card Billing Address: ______________________________________________________

Name of Company (if applicable): _______________________________________

Tax ID#(TIN) (if applicable): _______________________________________

Authorizing Agent (if company card): ______________________; Title: _________________________________

I hereby agree to the Service Agreement and Open Billing Agreement, which I have signed and submitted as well as the above terms and conditions. I also authorize Advanced Investigative & Screening Solutions to charge the payment according to the choice I made from options above.

Cardholder Signature: ____________________________________ Date: _____/_____/_____


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

A facsimile of the following signature is to be considered an original.