TO ORDER: please print out this form, fill in the information and fax it to 305-278-8702.

Credit Card Number:____________________________________

Exp Date:__________

Name as it appears on the card:_________________________________________

Billing Address:_____________________________

City, ST, Zip__________________

Telephone: ____________________________FAX:___________________________

I, the undersigned cardholder, give permission to The Wasser Agency to use the above credit card for payment of the purchase below. The total estimated cost for the services requested will be:

$______________

The undersigned cardholder is fully responsible for these charges which are payable in full to The Wasser Agency.

Signature:______________________________________

Search Subject:

Name: _________________________________________

Address: _______________________________________________________________________

Date of Birth: _________________________

Social Security #: _______________________

Driver's License Number: ___________________

Investigation Requests:

1)___________________________________________________

2)___________________________________________________

3)___________________________________________________

4)___________________________________________________

5)___________________________________________________