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VISA MASTERCARD AMERICAN EXPRESS DISCOVER

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In consideration of HARRY D. POLATSEK, P.A. (POLATSEK, COUNSELLORS AT LAW), accepting payment for services by credit card rather than by cash or check, the undersigned does hereby waive and relinquish any rights the undersigned may have now or in the future to protest, dispute or refuse to pay the full amount charged on such credit card. This waiver specifically applies to any rights conferred by law or by the credit card companies to dispute an amount charged based on the quality of services that were/are going to be rendered. The undersigned acknowledges that any payment by credit card for past services rendered is an affirmation that such services were performed/rendered satisfactorily. The undersigned acknowledges that any payment by credit card for services to be rendered in the future is a non-refundable retainer.

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