Credit Card Authorization Form Name On Card * First Name Last Name Card Type * MasterCard American Express Visa Discover Credit or Debit Card? * Credit Debit Credit Card Number * Expiration Date * Security Code * Cardholder Zip Code * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Call or text with amount for authorization before running card? * A reminder that payment is due on the day of service, if you can't be reached for authorization same day, late fees may apply until authorization is received. Yes No If no authorization required, would you like to specify a maximum transaction amount? Digital Consent Signature: * By electronically signing your name in the box below you are authorizing Big River Equine, LLC to retain your card information for payment processing. Thank you!
