CREDIT CARD APPROVAL

When you have completed your credit card form, Please either fax it to us or scan it in. Call the kennel if you have any problems or questions. Inquiries are always welcome. Fax to 610-933-1676 Email us at kimbertalkls@aol.com Phone us at 610-933-3600

(Please include a clear photocopy of your credit card and a clear photocopy of your driver's license. Thank you.)

I, ___________________________, do hereby authorize Kimbertal Kennels to charge (please print your name) $___________________ for a ______________________________________________. (breed, sex, and quality of the puppy being shipped) My credit card # is: __________________________________ Exp. Date: _____/_____ My name is: ____________________________ ________________________________ (First Name) (Last Name) Address: ________________________________________________________________ City: ___________________________ State: ________ Zip Code: _________________ Phone #: (______) - ________ - __________ Fax #: (______) - ________ - _________ Email Address: ___________________________________________________________ Nearest International Airport: _______________________________________________ My Signature: ____________________________________ Date: _____ / _____ / _____ I would like my dog to be named: ____________________________________________