EmailMe Form - BAREBACK PAD ORDER FORM

Have you ordered from us before?

Name *

First Last

Ship To Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Billing Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Is your Ship To Adress the same as your Billing Address? *

Yes

No

If you mark no please provide your billing address below

Is this location secure? *

Yes

No

Instructions

Please let us know if this delivery location is secure & if there are any special instructions for the driver.

Phone *

### - ### - ####

Email *

BREED OF HORSE *

RIDERS WIEGHT *

PICTURES OF ANIMAL

Describe any known issues with your animal.

And helpful comments.

Bareback Pad Options

STANDARD CONSTRUCTION INCLUDES:

ALL FLEECE BOTTOM W/ 2 FRONT RINGS & CENTER RING ON REAR, FRONT HANDLE, NON SLIP SEAT, & YOUR CHOICE OF REGULAR FOAM INSERTS AND NOW AVAILABLE WITH A FORWARD GIRTH

Bareback Pad

Regular Peak (281029 R)

High Peak (261229)

Regular Peak (281029 RFG)

High Peak (261229FG)

Foam Insert Options

1/2" Foam

3/4" Foam

1" Foam

Density Options

Medium Firm

Firm

Lamination Options

Light Duty

Medium Duty

Mule Foams

Top Material Options

Cordura Fabric Options

Solid Cotton Duck Fabric Options

Print Fabric Options

Wear Leather Options

**For Print Fabrics only**

Payment Information

Credit Card *

Visa

Master Card

Discover

Card Number *

0000-0000-0000-0000

Confirm

Expiration Date *

MM/YY

CVC NUMBER *

3 DIGIT CODE ON BACK OF CARD