STANDARDBRED STAKES PAYMENT FORM
NOTE: Daily $10,000 online payment limit is in effect.
Require Assistance with Payments?
CONTACT US:
Phone: 905-854-7805
OR call 1-888-675-7223 dial 1 ext 4306
Successfully completed – Transaction Information
Order # : {{Receipt.OrderNum}}
Reason for Payment : {{Receipt.ReasonForPayment}}
Sub Total Amount :
Fee ({{Receipt.FeePercentage*100}}%) :
Total :
Nominator Information
First Name : {{Receipt.Nominator.FirstName}}Last Name : {{Receipt.Nominator.LastName}}
Phone# : {{Receipt.Nominator.Phone}}
Billing Information
Address : {{Receipt.CreditCard.Billing.Address}}
City : {{Receipt.CreditCard.Billing.City}}
Province : {{Receipt.CreditCard.Billing.Province}}
Country : {{Receipt.CreditCard.Billing.Country}}
Postal Code : {{Receipt.CreditCard.Billing.PostalCode}}
Name on Credit Card : {{Receipt.CreditCard.Billing.FirstName}} {{Receipt.CreditCard.Billing.LastName}}
Card# : xxxx-xxxx-xxxx-{{Receipt.CreditCard.Token.substr(12,4)}} ({{Receipt.CreditCard.Type}})
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