Lease Authorization Press American Paint Horse Association

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					Lease Authorization
                 American Paint Horse Association
                 Mailing Address: P Box 961023 N Fort Worth, Texas 76161
                 Physical address: 2800 Meacham Blvd., Fort Worth, Texas 76137
                 (817) 834-APHA (2742) N Fax (817) 834-3152

Leasing Your Horse                                      Registered Name of Horse: __________________________________________________________________________________
N Alterations or added conditions may make
  this form unacceptable, and verification              Registration Number: ______________________________________________________________________________________
  may be required.
N If the Lessee is a ranch, partnership or corpo-       The Lessee is authorized to sign all documents pertaining to this horse under the rules of the American Paint Horse
  ration, a signature authorization must be             Association during this period. At the expiration of this lease, the lessee’s authority will be terminated.
  placed on file with APHA before this lease can
  be recorded. Forms are available from the
                                                        Beginning Date: _____________/ __________/ _____________                       Ending Date:______________/ _________/_______________
  APHA office or online at                                       month                day                year                                  month                  day                 year
N If this lease is to be terminated prior to the
  ending date listed, written notification must
  be received by APHA giving new termination
                                                        Leased From (Owner of Record)                                                   Leased To (Lessee)
  date and signed by both lessor and lessee.
N No transfer may be completed until this lease
  is expired or terminated.                             Name: ____________________________________________                              Name: ____________________________________________
N Lessee will receive a certificate from APHA as val-
  idation upon completion of lease authorization.       APHA ID Number: __________________________________                              APHA ID Number: __________________________________
N Leases are not recognized for showing purposes
  in either Amateur or Youth classes. Please con-       Address: __________________________________________                             Address: __________________________________________
  tact the Performance Department at 817-222-
  8455 for more information.                               ________________________________________________                                ________________________________________________
N To take advantage of member rates, the lessee            ________________________________________________                                ________________________________________________
  must have a current membership in the same
  name listed on the form. Memberships will be          Daytime Phone Number: ____________________________                              Daytime Phone Number: ____________________________
  issued in the ownership listed on this form.
  Memberships begin the same month transfer is          Email: ____________________________________________                             Email: ____________________________________________
N If a membership is not purchased, nonmem-
  ber fees will apply. Please see fee schedule in
                                                        Signature: ________________________________________                                             X
                                                                                                                                        Signature: ________________________________________
  Rule Book.
N For more information, call Customer Service
  at 817-222-6423 or email
N Average lease completion times range from two         Fees                 U.S. Funds Only         Member Rate                I Check or money order enclosed. Do not send cash.
                                                                                                                                   Check Processing Policy: In the event that your check is returned unpaid for
  to four weeks, depending on the time of year sub-     I Lease Filing Fee                                  $15                    insufficient or uncollected funds, we may present your check electronically.
  mitted. The following is required on rush work:       I Rush Lease (requires an additional)               $25
  1. Outside of envelope marked “RUSH”                                                                                          I MasterCard             I Visa         I American Express
                                                        Membership Levels
  2. Daytime phone number                               Adult                           Junior (18 or younger)
  3. Certified funds or a credit card payment           I One-year—$40                  I One-year—$20                          If paying by credit card, please complete the following.
N The rush fee will not be refunded.                    I Three-year—$90                I Three-year—$40
N An office processing fee of $10 will be charged                                                                               Card No.: ______________________________________________________________________________
                                                        I Five-year—$150                I J-Term—$100
  on all registration work that is not processed
                                                        I Lifetime—$500                 Birthdate: _____ /______ /_____
  to completion.
                                                                                                                                Exp. date: _______________________________________ CVV#:_____________________
N Fees subject to change without notice.                Additional Product Packages:
                                                        I Premium—$45 (save $20), US ONLY. One year subscrip-
Online Access                                                                                                                              ______________________________________
                                                        tion to the Paint Horse Journal($30 value), four generation, Name of Cardholder: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
N My APHA (free to APHA members). Includes              frameable, pedigree certificate($20 value), $15 gift certifi-
  online stallion breeding reports and foal             cate to the APHA General Store
                                                        I Deluxe—$15 (save $5) Four generation frameable,             APHA ID No.:_________________________________________________________________________
N APHA Basic-$25 per year. Includes pedigrees,          pedigree certificate ($20 value)
  performance records, progeny records and                                                                                      Address: _____________________________________________________________________
  show results.                                         Total Amount Due
N APHA Plus-$14.95 per month; $99 per year.                                                                                     City:________________________________ State: ____________ Zip:____________________
                                                                        Lease Fee: $________________________
  Includes “My Barns”, Color Calculator, show
  records and extras.                                                    Rush Fee: $________________________                    Daytime phone:_______________________________________________________________________
                                                         Online Access Service: $________________________
                                                              Membership Dues: $________________________

                                                                Product Package: $________________________

                                                                           TOTAL $ ________________________

Rev. 11/11

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