Credit Card Authorization Form Name On Card * Card Type * Visa Mastercard Discover American Express Card Number * Expiration Date * 00/00 Security Code * Billing Zip Code * Client Acknowledgement: * I authorize Chesapeake Equine Performance to charge this credit card for services rendered. I acknowledge that this authorization will remain in effect until it is canceled in writing. I also agree to notify the vendor in writing of any changes in my account information. Chesapeake Equine Performance uses a third-party company Worldpay to safely store your data in encrypted form. Yes Electronic Signature Authorization: * I agree and consent to use electronic signatures, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. If I do not initial this Authorization, then I understand I must remit this form with my handwritten signature. YES Client Name * Client Signature * Please type your full name as your valid electronic signature Today's Date * MM DD YYYY Thank you!
