Online Payment

"a SHOT ABOVE THE REST"

The Smoking Barrel, LLC

Card Type: *

ZIP Code: *

Security (CVV) Code: *

STOP!

DO NOT FILL OUT AND SUBMIT THIS FORM UNTIL YOU HAVE CALLED THE SMOKING BARREL, LLC AT (308) 575-0246 AND SIGNED UP FOR A COURSE.

Email: *

Expiration Date: *

Credit/Debit Card Number: *

Are you or your spouse past or present Military? *

Name as it appears on credit/debit card: *

Street Address (No P.O. Boxes) *

Number of people being paid for: *

YOUR PAYMENT WILL NOT BE PROCESSED AND YOU WILL NOT BE SIGNED UP FOR A COURSE UNLESS YOU HAVE CALLED THE SMOKING BARREL, LLC AT (308) 575-0246 AND SIGNED UP FOR A COURSE PREVIOUS TO SUBMITTING YOUR PAYMENT INFORMATION.

Telephone Number: *

Course Date You Are Signing Up For (example Jan. 7, 2017) *