|
Pacific Coast Cutting Horse Association
P.O. Box 108
Lockeford, CA 95237
Phone: (209)727-5779
Fax: (209)727-5743
Credit Card Authorization
Please Circle One: Amex Master Card Visa
Card Number:____________________________________________________
Expiration Date:____________________ CSC No.:______________________
3-4 digits on back of card
Or for Amex - 4 digits on front of card
Name on Card:____________________________________________________
Billing Address of Card:____________________________________________
Street or P. O. Box
__________________________________________________________________
City, State, Zip
Amount:____________________________________________________________
Signature:___________________________________________________________
Description of Charge:_______________________________________________
Entries, Stalls, Stallion Nomination, Banquet, Etc.
Date:_______________________________________________________
5% additional charge for credit card use
|
.jpg)
.jpg)
