Request to Purchase by Credit or by Check

Complete Both parts and Mailed to Barrets as soon as possible to Date of Sale To: Barretts Equine Limited P.O. Box 2010 Pomona, CA, 91769 Date:______________ SALE:______________________________________________________________ Amount of Credit Desired: $___________________________ ________________________________________________________________________________ Name Drivers's License # ________________________________________________________________________________ Farm or Stable Name Home Phone # ________________________________________________________________________________ Address Business Phone # ________________________________________________________________________________ City State Zip Social Security Number ________________________________________________________________________________ Licensed Owner/ Trainer Lic. # State ________________________________________________________________________________ Trainer's Name (if applicable) Next Part Must be Completed

Request to Purchase by Credit or by Check Bank Information

The Credit Applicant whose signature appears below has had an account with this bank for _________ years. The Average balance of this account during the past two years has been in the range of $___________________________________________________________________ ________________________________________________________________________________ Signature of Bank Officer Account No. ________________________________________________________________________________ Bank Officer (Please Print) Title ________________________________________________________________________________ Name of Bank ________________________________________________________________________________ Address City & State _(_____)________________________________________________________________________ Telephone Number ________________________________________________________________________________ Signature of Credit Applicant By signing this Credit Request, applicant authorizes Barrets to perform a credit investigation

Subscribed and sworn to before me this ___________day of____________________________________________ , 19_____ _______________________________________________________________________ Notary Public County_________________________________________________________________ My commission expires on _______________________________________________