One Time Credit Card Payment Authorization Form

Sign and complete this form to authorize Royal Equestrian Collection to make a one time debit to your credit card listed below.

By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

PRINT AND COMPLETE THIS AUTHORIZATION AND RETURN.

All information will remain confidential

Please complete the information below:

I (full name) authorize Royal Equestrian Collection to charge my credit card account indicated below for (amount) on or after (date). This payment is for (description of goods/services/or order number)

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Return the completed and signed form to the following:

Fax: 805-410-4494 or email: [email protected]