VIEWS: 1 PAGES: 1 POSTED ON: 4/3/2013
Farrier Art Full Service Horseshoeing AUTHORIZATION to CHARGE CREDIT CARD All items with a * are required! Choose Visa or MasterCard * Chris Minick Charge to Credit Card Account Number: * AFA Certified Farrier 34 Sunrise Avenue Expiration date on card: Month * Year * Mill Valley, CA 94941-3339 3 or 4 number security code on back of card in signature line: * 415-383-6727 Fax & Office 707-775-7836 Mobile Name * 415-302-6727 Mobile firstname.lastname@example.org Address * www.farrierart.com City * State Zip Code Home Phone * Mobile Phone * Work Phone * Your Email * Terms and Conditions 1. Payment is expected at time of service—cash, approved check, credit card or ATM/debit card unless other arrangement have been agreed to in advance. A 5% charge will be added for credit cards (or a $0.50 charge for debit cards) will be added for the recovery of processing and transaction fees charged to Farrier Art. We will accept checks but only with the backup of a credit card on file with Farrier Art. There is a $30 fee for checks returned for insufficient funds, and your credit card on file will be charged the balance due. 2. Someone must be available to catch and hold the horses and to present payment unless other arrangements have been agreed to in advance. 3. The location must be a safe, clean, flat, dry, and well-lighted place to work. 4. Horses must be trained and well mannered. Additional charges will be added if physical restraint is necessary. I will stop work if horses present a safety hazard to themselves or anyone in the area. Veterinary services to administer chemical restraint must be arranged for in advance. If work has to be halted because of the horses behavior, you will be charged for our time. 5. A 24-hour notice prior to appointment must be given for any appointment changes. This includes: Adding or subtracting horses from the appointments schedule, changing what is scheduled to be done to the horse, canceling an appointment, etc. Within 24-hours of your appointment time, a change fee of $25.00 may apply. 6. Unless another arrangement is agreed to in advance, we will travel fifteen miles for free, after that, we charge a mileage fee of $3.00 per mile, one-way. A 50 mile trip would therefore add a flat-charge of $105.00, regardless of the number of horses being serviced. Acceptance and Authorization The cardholder attests that the above information is correct, that he/she has read and understands the above Terms and Conditions, and that he/she consents to the use of his/her credit card in payment of appropriate invoices, according to the terms and conditions of the issuer. The cardholder acknowledges that if this form is submitted by fax or by email, said fax or email would be deemed an original. By clicking here I acknowledge that I have read and accept the Terms and Conditions and Acceptance and Authorization herein. All items with a * are required! Click here to submit by Email (easiest way) Date:* Signed By (if submitted by paper or fax 415-383-6727)
"Download the Credit Card Authorization Form in PDF - Chris Minick "