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Client Intake  & Payment Authorization Form

PO Box 173, Circleville, OH 43113 | www.equineconnectionsconsulting.com

CLIENT INFORMATION

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HORSE INFORMATION

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Services Requested
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PAYMENT INFORMATION

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Additional Fees May Include:

  • Processing Services
  • Registry Fees
  • Expedited Requests

CREDIT CARD AUTHORIZATION

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AUTHORIZATION AGREEMENT

I authorize Equine Connections Consultants, LLC to charge my card for:

  • Monthly Service Fees
  • Additional Processing Fees
  • Registry Third-Party Fees
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