OQHRA Payment Form

Hair Testing Payment for On-Site Testing

HORSE MUST ALREADY HAVE AN APPOINTMENT
Horse Information:

Please be sure all information is completed!
Trainer:*

First NameLast Name
Payment Information

Quantity, be sure the number of horse names and the number of tests in the dropdown match! You can schedule up to 10 horses at a time, when you drop down more in the quantity box below more name boxes will appear above. *

On Site Hair Test

$240.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Horse 1:*
Complete Registered Name
Horse 2:
Complete Registered Name
Horse 3:
Complete Registered Name
Horse 4:
Complete Registered Name
Horse 5:
Complete Registered Name
Horse 6:
Complete Registered Name
Horse 7:
Complete Registered Name
Horse 8:
Complete Registered Name
Horse 9:
Complete Registered Name
Horse 10:
Complete Registered Name
Submitter Name:*

First NameLast Name
Submitter Phone:*
Please enter a valid phone number.
Submitter Email:
example@example.com
At this time we are unable to store credit cards via this system for future use. If you'd like to leave a card on file for future transactions, please call (405) 881-5120 with the card information.
Save this card for future? When your trainer schedules another horse of yours we can automatically charge this card?
Should be Empty:

Hair Testing Payment for On-Site Testing

Horse Information:

Payment Information

At this time we are unable to store credit cards via this system for future use. If you'd like to leave a card on file for future transactions, please call (405) 881-5120 with the card information.