SANDSTONE MOUNTAIN RANCH
AN ENTITY OF ALBERT L ANDERSON FAMILY LIMITED PARTENERSHIP


CREDIT CARD AUTHORIZATION FORM - 3% FEE WILL BE ADDED

PLEASE PRINT THIS OUT, COMPLETE THE FORM AND RETURN IT TO US
All Information will remain confidential.

CARD HOLDER NAME:____________________________________________________________

BILLING ADDRESS:_______________________________________________________________

CITY, STATE, AND ZIP:____________________________________________________________


CREDIT CARD TYPE:     VISA:________    MASTERCARD:_________    DISCOVER:_________

CREDIT CARD NUMBER:__________________________________________________________

EXPIRATION DATE:_____________     CIN NUMBER ON BACK OF CARD:________________
                                                                   (Last 3 digits located on the back)

AMOUNT TO CHARGE   $___________________________ USD    +  3% FEE


I authorize Sandstone Mountain Ranch to charge the agreed amount listed above to the credit card provided herein.  I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.  I understand that I will be charged and additional 3% convenience fee for using a credit card.

CARD HOLDER – SIGN, PRINT NAME, AND DATE BELOW.  PROVIDE EMAIL FOR RECEIPT.

SIGNATURE:_________________________________________________________
                      
PRINTED NAME:______________________________________________________
                            
DATE:_______________________________________________________________

EMAIL:______________________________________________________________


Sandstone Mountain Ranch - Albert L. Anderson Family Limited Partnership
MAILING:  P.O. Box 550  -  Llano, Texas  -  78643
4825 East State Hwy 71  -  Llano, Texas  -  78643
Phone (325)247-4252
www.SandstoneMountainRanch.com
SandstoneRanch@aol.com