Photo of Trophy

 

Grand Champion At Halter Trophy

 Order Form

 

Some recommended layouts for the trophy plate:

 

1)

    Horse Name                                

Grand Champion                 

    Event name, date                         

 

2)

   Horse Name

Grand Champion & Date

   Event location

 

3)

    Horse Name

Open/Amateur/Youth Grand Champion

    Location, Date

 

 

 

 

Print exactly as you want to appear.

 

 

Line 1:__________________________________________________________

Line 2:__________________________________________________________

Line 3:__________________________________________________________

 

(Print size may be reduced depending on space and letters)

 

 

 

______ Quantity @ $150.00 each =$_________

                                                  $         10.00 shipping and handling

                                                  $_________ administrative fee if applicable

                                                  $_________ Total Enclosed

 

Orders will not be completed if US funds are not enclosed with order form.

Payment information:  (Check, money order or credit card.)

Fees above are the Discount for Cash and Check paying Customers.

 

Please circle one:     Check        Money Order        Visa          MasterCard     

Credit card information:  

Card Number:__________________________________________________________________________

Expiration date on card:_____________________ Name on card:_________________________________

Signature:________________________________ Last three security digits on back of card:____________

 

 

Contact and mailing information:                          Please Print clearly.

Name:

 

Address:

 

City:

 

State:

 

Zip:

 

Daytime Phone:

 

Fax:

 

Email:

                                                                    @

 

 

 

 

 

 

 

 

 

 

 

Please allow 8-10 weeks for delivery.

Mail entire form to:

Palomino Horse Breeders of America

15253 E Skelly Dr

Tulsa, OK 74116-2637

Ph. 918-438-1234           www.palominohba.com

Credit card orders may be faxed to: 918-438-1232