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.