SILVERWOOD FARM  
39331 Rodeffer Rd.
  Lovettsville, VA. 20180

Phone/Fax (540) 822-9110
email: pintofoal@aol.com
www.silverwoodfarm.com


Please do NOT send credit card info via email,  it is not secure

Credit Card Fax & Phone Form
hit your return button after printing to return to previous page or click here for main directory

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 pintofoal@aol.com

Instructions
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:    _____  / _____
                      
          Month    Year

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: (      ) _____________________
Email: __________________________________

THANK YOU
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.