SUPERIOR AWARD PLAQUE
Order Form
Print exactly as you want to appear.
Superior award event: ___________________________________________
Date Issued:___________________________________________________
Horse name: ___________________________________________________
______ Quantity @ $50.00 each =$_________
$ 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.
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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