TRI STAKES
Slot Purchase Form
Slot owner name (can be a business)
Slot Owner Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Rider Name
Rider Phone Number
Please enter a valid phone number.
Is Rider address the same as slot owner address. If so, skip the address info below.
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Horse Registered Name
Owner of Registered horse
Please upload registration papers of horse placed in slot.
*
Browse Files
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Choose a file
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Is horse eligible for Gridiron Breeders' Incentive?
Please Select
Yes
No
Is horse eligible for Lucky 7 Bonus?
Please Select
Yes
No
Has slot owner ever been a member of Northern Futurity Finale?
Please Select
Yes
No
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Tri Stakes Slot
One slot in Tri Stakes
$
500.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: