CREDIT
CARD AUTHORIZATION FORM
Phone: 916-687-6384 – FAX: 916-687-4731
Any payment for services invoiced
prior to the 1st of each month, including, but not limited to
training, board, supplements, horse show expenses and applicable late fees, not
received in our office by the 10th of each month will be directly
charged to your credit card. In
addition, all charges for services by others contracted by Ken Wold Training
Stables including, but not limited to Farrier, Veterinarian, Acuscope Therapy,
Chiropractor, Equine Dentist, and Bioscan Therapy will be charged directly to
your credit card. All charges will be
assessed a 4% processing fee.
By signing this document and
providing the information requested below, I authorize Ken Wold Training
Stables to the conditions of this agreement and release any liability against
Ken Wold Training Stables.
_________________________________ ________________________________
Signature Date Signature - Ken
Wold Training Stables
Name (as it appears on credit card):
________________________________________________
Credit Card Billing Address:
_______________________________________________________
_______________________________________________________
Credit Card Type: Master Card VISA
Credit Card Number: ____________________________ Expiration: _____________________
ORIGINAL
COPY – Office * YELLOW COPY – Horse Owner