Please read and complete this document and fax back to 305-233-1954

Client must provide a credit card number to be kept on file with SFN, Inc.  This credit card will be used to bill the initial deposit (retainer) of $120.00 if applicable and any other balances due to SFN, Inc. POST placement of your new employee.  We do not send invoices.  Client also understands that the balance of the agency placement fee is due upon employee(s) begining their first day of work.  Client also understands that this same credit card will be used to pay for employee deductions. Copy of this form shall serve as your receipt.  You may request a statement of your account at any time.

Please circle one: Visa, Master Card, American Express

Please print clearly

Card holder name:           ______________________________________

Card number:                   ______________________________________

Expiration Date:               ______________________________________

Complete billing address:  ______________________________________

Billing Zip Code:              ______________________________________ 

I have read and understand all of the above mentioned conditions.     

Card Holder's signature:  ___________________________

Date:                                ________________