Sign and complete this form to authorize Jacob Livestock to make a debit to your credit card listed below.

By signing this form you give us permission to debit your account for the amount indicated on your invoice on or after the date shown on your invoice. PLEASE NOTE: This permission is for ALL transactions where you or your representative have endorsed your invoice AND for transactions where you have requested delivery and you or your representative will not be present. Card purchases are subject to an additional
approx. 3% convenience fee.

"*" indicates required fields

Type Of Card:*
Type Of Card
Print Full Name of Card Holder:*
Billing Address Of Card:*
MM slash DD slash YYYY

I authorize Jacob Livestock to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described in my Jacob Livestock (JL) invoices, for the amount indicated in my JL invoices, and is valid every time my representative or I pick up or have goods delivered from JL. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated on my JL invoice.

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