NC Hunter Jumper Association
Secure Payment Form

 
Please completely enter all information and allow up to 5 business days for processing of your horse recording.
Horse Information:
Order Date: 11/18/17
Horse Recording Type/Amount
(includes processing fee):
* Horse/Pony Name:
** Owner Name:
** Lessee Name:
Horse Sex:
Horse Breed:
Color:
Height:
* Horse Recordings are lifetime so you do not need to re-record your horses.
 
** Either the Horse Owner or Lessee entered here must be a current NCHJA member. If a membership has not been previously submitted you will be contacted by the NCHJA office. Horse Recordings are lifetime so you do not need to re-record your horses.
           
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 
[What is the Card ID?]
   
Billing Information:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Phone Number:
Email Address: