This document is intended to authorize Cornerstone Kennels to process the following credit card charges:

INSTRUCTIONS FOR COMPLETING THE SALES SLIP:

1.  Before printing, please select all appropriate categories for [Description|Quantity|Breed|Amount] from the drop down lists below.
2.  After you have made your category selections, Print This Page.
3.  Complete ALL remaining information before submitting by fax.

PLEASE NOTE:  
For PRINTED NAME:  The Cardholder's name must be written exactly as it appears on the card.  If the Cardholder is someone other than the Customer, please include the Customer's name in the information space provided below the sales slip.

         *FOR CK USE ONLY.  PLEASE LEAVE THESE SPACES BLANK.

CARD NUMBER __ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __	*DATE	*AGENT	*INVOICE No.
EXPIRATION DATE (MONTH / YEAR ONLY) _____/_____	Description | Quantity | Breed | Amount ---------------------------------------- Balance Due | One (1) | Havanese | $1500.00 Balance Due | Two (2) | Havanese | $3000.00 Balance Due | 1 | Coton de Tulear | $1700.00 Balance Due | 2 | Coton de Tulear | $3400.00 Shipping Fees | One (1) | Puppy | $250.00 Shipping Fees | Two (2) | Puppies | $275.00
	Please select before printing this page Description | Quantity | Breed | Amount Balance Due | One (1) | Havanese | $1500.00 Balance Due | Two (2) | Havanese | $3000.00 Balance Due | 1 | Coton de Tulear | $1700.00 Balance Due | 2 | Coton de Tulear | $3400.00 Shipping Fees | One (1) | Puppy | $250.00 Shipping Fees | Two (2) | Puppies | $275.00 ----------------------------------------
PRINTED NAME _________________________________________	Please select before printing this page Description | Quantity | Breed | Amount Balance Due | One (1) | Havanese | $1500.00 Balance Due | Two (2) | Havanese | $3000.00 Balance Due | 1 | Coton de Tulear | $1700.00 Balance Due | 2 | Coton de Tulear | $3400.00 Shipping Fees | One (1) | Puppy | $250.00 Shipping Fees | Two (2) | Puppies | $275.00 ----------------------------------------
	---------------------------------------- Charge Processing Fee | 1 | Puppy | $50.00 Charge Processing Fee | 2 | Puppies |$100.00
CARDHOLDER'S SIGNATURE X Cardholder authorizes the charge for goods and/or services in the amount of the Total shown heron and agrees to perform the obligations set forth in the Cardholder's agreement with the issuer.	Sales Slip	*APPROVAL CODE:	:::::::::::::::::::::::::::::::
		Total:  $_________________

CUSTOMER INFORMATION:  If other than the Cardholder above.

Name: _________________________________________________________________________________________

CARDHOLDER INFORMATION:  Please include the billing address for the account being charged.
                                                                   
Street Address:___________________________________________________________________________________

City, State & Zip:__________________________________________________________________________________

Phone:___________________________________________Fax:____________________________________________

By completing this document and returning it in addition to your deposit agreement &/or your shipping addendum, the Cardholder authorizes Cornerstone Kennels to make charges to the above listed credit account. "Balance Due" payments made by credit card include a processing fee not associated with payment made by cashier's check, money order or cash. "Shipping Fees" paid by credit card will not include additional processing fees. We will not process this form or make charges to any credit card without the accompaniment of the appropriate documents of agreement.