Payment Authorization Form

• We offer the convenience of charging your lessons, show bills and/or services provided to your VISA, MasterCard or AMEX.
• All lessons must be prepaid on the first of every month.
• All lessons on auto-billing will be charged to your account upon expiration of prepaid monthly lessons on or before the 5th of every month.
• If there are any discrepancies, they must be brought to our attention within the 5-day period of the invoice date.
• To use this service, please complete and submit the form below.
• Your credit card authorization must be signed and on file before any charges can be made.

Cardholder Name (as it appears on card) *

Email *

Type of Card *VISAMASTERCARDAMEX

Card Number *

Expiration Date *

Security Code/CVV *

Billing Zip Code *

Payment Confirmation *

• I hereby authorize Four Gs Equestrian to charge my credit card for agreed upon lessons, show bills and or services provided. I understand my information will be saved on file for future transactions on my account..

Signature (Use your mouse, or finger/stylus on touch screens) *

Clear Signature

Date *

Submit