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DocuSign Envelope ID:7883307E-C860-4560-99B8-EE98E3EB6B35 <br /> t>z <br /> Date: <br /> FOR BUSINESSES THAT WANT TO PAY WITH CREDIT CARD <br /> Created on: Sy: Initial Charge for WO#3l- - For work date of: <br /> Account##: 3l- - Additional Charge: S Refund: <br /> Company/Individual Name: <br /> Billing Address: City: State: Zip: <br /> Street Address: <br /> City: State: Zip: Email Address: <br /> Phone Number: Fax: Cell: <br /> AUTHORIZATION TO CHARGE ACCOUNT <br /> I, ,authorize Labor Finders to charge the credit card(listed below) for <br /> temporary employment services that I receive. This authorization is good for all such services from this date <br /> forward that are authenticated by signed work orders indicating the number of hours per employee. I <br /> understand that the charges that will be placed against my credit card will be determined by multiplying the <br /> total hours per work order by the applicable hourly bill rate. Other charges that may be incurred if requested <br /> by customer are, background checks,drug screens, waiver of subrogation and a daily transportation charges <br /> that may be indicated below. <br /> The initial charge for services is $ L_Hours@ X Number of <br /> Persons Plus ) <br /> 4 Hour Per Person Minimum <br /> Our bill rates per person per hour: $ /hr-for Labor Light. $ for Labor Plus/Demo. <br /> $ for Semi-skilled Labor, $ for Skilled Labor. A Transportation charge of$ per day. <br /> (check one) OMaster Card 0 Visa ()American Express 0 Discover Other <br /> Card #: Exp. Date: - - <br /> Name on Card: <br /> CV2 Code: (This is the three digit code on the back of the credit card) <br /> Sign Here <br /> Authorized Card Holder's Signature Required <br /> 2 Please Read And Complete All Pages And Return To Us For Processing Form CAT April 2018 <br />