Credit Card Fax & Phone Form
Please use this form for faxing or calling in your credit card information-DO NOT SEND your credit card information via email since it is not a secure site to protect your credit information. If you would like to pay on-line, you can do so securely via our buy it now buttons or via Paypal making payment to firstname.lastname@example.org
Please print out the following form, fill out the information and then either fax it too (540) 822-9110 or call the same number to leave the information requested on the form, please also print out a copy of the contract for your records. When faxing please fax the first page only of your filled out contract and the below form/information.
Please print legibly
Name (as it appears on the card):____________________________________________________
Full address & zip code
(as it is billed from your card):__________________________________________________________________________________
Card Type: ______ Visa ______ Mastercard ________AMEX ________ Discover
Card #: _________________________________ Card verification number: ______ (3 numbers on back of card-AMEX 4 on front)
Expiration date: _____ / _____
Amount you authorized to be charged :$________________
If you have questions about fees, discounts, etc. Please call (540) 822-9110
For: stud fee ____ booking fee____ container/shipping fee____ sale ____ other ____
Name and address if different then above: ______________________________________________________
Phone number: ( ) _____________________
© 2005 The written material/contract, images on this page are copy write protected and are the property of Silverwood Farm. It can not be copied or modified without written permission of Silverwood Farm.