| EquineMax Order Form |
Rancho Media, LLC
P.O. Box JG
College Station, TX 77841
Fax: (877) 637-8463 / Phone: (877) 637-8463
If submitting order by mail, please allow 7-10 business days for your order to be received and processed.
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Name:_______________________________________________________________________
Farm/Ranch:___________________________________________________________________
Mailing Address:_______________________________________________________________
City/State/Zip:_________________________________________________________________
Phone Number:________________________________________________________________
E-mail:_______________________________________________________________________
Credit Card Information
(if paying via credit card):
Additional computer licenses? ($35 each)
______ Online backup service?($40 year)______
Total enclosed _________
Card Type Visa Mastercard Discover American Express
Card Number ______________________________________ Exp ____________ CVC ____________
The CVC (card verification code) is a 3-digit number located on the back of the credit card)