FAX NUMBER: (877) 471-6902 Info@SIAinvestigations.com To: SIA INVESTIGATIONS 1099 E Champlain Drive, STE A-1073, Fresno, CA 93720 on all forms. TELEPHONE: (877) 574-4411 FACSIMILE: (877) 471-6902 Date: Subject Of Request: From: YOUR EXACT NAME YOUR EMAIL: COMPANY NAME: CITY: STATE: ZIP CODE: BY THIS MEMORANDUM AND AUTHORIZATION, I ORDER THAT SIA INVESTIGATIONS BE PAID FOR THE TRANSACTION OF THE ABOVE-REFERENCED INDIVIDUAL/COMPANY IN THE AMOUNT OF*: DOLLARS ($): BY USING MY CREDIT CARD SPECIFIED AS: MastercardVisaAmerican ExpressDiscover CREDIT CARD NUMBER: EXPIRATION DATE: 3- OR 4-DIGIT: SECURITY CODE (on back of card) I understand and acknowledge the charge I hereby authorize for the above-specified services. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, provided the transactions correspond to the terms indicated in this authorization form. I further agree that, by signing this agreement, I am agreeing to the terms and conditions, and privacy notice, of the website through which I contacted SIA, Inc., and those of all related websites owned and operated thereby.Your credit card charge will appear as “SIA, Inc.” on your statement. Submit