WPEM Accepts VISA, & Mastercard for Payments Credit card transactions will be processed at retail prices
To use your Visa or Mastercard to pay for the amount due with entry(ies) such as horse deposits, stalls, RVs, etc., please complete the form below and send with your entry(ies). Please Note: This form must be filled out completely. All fields are required in order to process payment. Incomplete forms may cause entry(ies) to be considered late. Amount due with entry(ies):
Stall + Nomination Fee per horse = $
Trainer: Phone: This credit card is used for the following horse(s): Horse 1_______________________________________Horse 2______________________________________ Horse 3_______________________________________Horse 4______________________________________ Horse 5_______________________________________Horse 6______________________________________ (If you have more horses please add them on an additional sheet)
____________________________________________________Phone: _______________________Email:__________________________ Name on Card (exactly as it appears)
Billing Address of Card
VISA MC
City
State
(Circle one) ___ ___ ___ ___- ___ ___ ___ ___-___ ___ ___ ___-___ ___ ___ ___
Zip
____ ____ /____ ____ Expires (MM/YY)
____ ____ ____ Security Code
I authorize WPEM to change my card for all amounts due WPEM with respect to the enclosed entry(ies) X__________________________________________________ Signature
_________________ Date
_________________________________________ Print Name