Hobby Horse

1769 Thierer Road

Madison, Wisconsin 53704

FAX Number 608-241-1313

Hobby Horse Wisconsin, Inc. Credit Card Authorization Form

This is our credit card authorization form. Please print this form, complete it, and sign it. Then FAX the completed form and a legible copy of your credit card, front and back, to our FAX number, 608-241-1313.

1> Order number.

2> Products ordered:

Quantity____Discription________________________Price______

3> Card Number___________________________________

4> Expiration date_____________

5> Cardholder name________________________________________

6> Cardholder billing address__________________________________________________________________________________________________

7> I authorize Hobby Horse Wis. Inc. to charge $__________USD to the card listed above.

8> Cardholder signature. Must be in your own handwriting.

X___________________________________________________

9> Today’s date____________________

Thank you for your cooperation and your business.

Hobby Horse Wisconsin, Inc.

1769 Thierer Road

Madison, Wis. 53704