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 VERIFIED THAT THE COURSE DATE IS AVAILABLE.

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 REGISTERED FOR A COURSE UNLESS YOU HAVE CALLED THE SMOKING BARREL, LLC AT (308) 575-0246 AND VERIFIED THAT THE COURSE DATE IS AVAILABLE PREVIOUS TO SUBMITTING YOUR PAYMENT INFORMATION.

IF PAYMENT IS NOT MADE THE SAME DAY AS YOU CALL, THE COURSE DATE MAY BECOME UNAVAILABLE IF OTHER REGISTRATIONS ARE FINALIZED BEFORE YOU SUBMIT YOUR PAYMENT. IN WHICH CASE, YOUR PAYMENT WILL NOT BE PROCESSED AND YOU WILL BE NOTIFIED.

BY SUBMITTING THIS PAYMENT FORM YOU ARE AUTHORIZING THE SMOKING BARREL, LLC TO PROCESS YOUR ONE-TIME CREDIT/DEBIT CARD PAYMENT. THANK YOU.

Telephone Number: *

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