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____________________________________________ , 20_____ _______________________________________________________________________ Notary Public County_________________________________________________________________ My commission expires on ______________________________________________