Angelstone Prize Money Payout Request

IMPORTANT - PLEASE READ: Angelstone policy is to roll forward credits to the next event. If the owner or rider is requesting prize money to be mailed out, this form is mandatory. This form must be submitted within 7 days of the event for FEI payouts, or within 15 days of the event for National payouts.

Rider Name

Owner Name

Trainer Name

Horse Name

Horse Number

Multiple Horses

Additional Horse 1 Name

Additional Horse 1 Number

Additional Horse 2 Name

Additional Horse 2 Number

Additional Horse 3 Name

Additional Horse 3 Number

Additional Horse 4 Name

Additional Horse 4 Number

Payee (who the cheque is made out to)

Payee Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Payee Email

Payout confirmation will be sent here

* A confirmation email will be sent to the email address on file with the entry form. If a different email address is on file, the request must be verified through that email address.

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Payment Method

Payment Details (optional)

Upload a void cheque or your wire transfer information for payment.

Payout Request

* Incomplete forms, or forms not submitted, will result in the credit being rolled forward to the next event.