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Credit Card/Debit Card Authorization Form

Visa      Mastercard 
Credit Card Number:
Expiration Date:
Security Code:
Name on Card:
Zip Code:
Phone #:
Billing and Credit Policy:
We accept cash, checks, Visa & Mastercard. All clients must place a credit card onf ile. All new clients must pay for services at the time of the appointment until credit is established. For all clients for whom credit has been established, payment is due upon receipt of each invoice or statement.
  I authorize Colts Neck Equine Associates to charge my credit card for any services provided for my horses. I understand that I am responsible for any charges incurred by me or my trainer/barn manager on my behalf. My credit card will be charged at the end of the month that the charges occurred.
  I prefer to pay by cash or check and will pay within 30 days of recieving the invoice. If I am unable to pay promptly I authorize Colts Neck Equine to charge my credit card for any charges incurred on my behalf by me or my trainer/barn manager.
  I understand that without a credit card on file Colts Neck Equine will not be able to perform routine or emergency work on my horses and I will make alternate arrangements.
Please look over all of your information to make sure it is spelled correctly and all of your contact information is in order!