Make A Payment – BuckDaddys Hunting Club

Please provide the following Information:

Member's Name*

First Last

Cardholder's Name*

First Last

Cardholder's Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Work Phone

Email

Property you are assigned to. May provide county or city if you don't know the number.

Membership - Full Payment - $930 - NOTE - ON NEXT PAGE, SELECT OTHER AND PUT IN $930 UNDER QUANTITY. Thank you!

Opt Out Fee - $100

Quantity

Other Amount NOTE - ON NEXT PAGE, SELECT OTHER AND PUT IN THE AMOUNT UNDER QUANTITY. Thank you!

If paying an amount other than what is listed above, please specify amount and purpose.

$ Amount:

Purpose:

By submitting this form, credit card or debit card, and electronic signature, I state and represent that I am 18 years of age or older, I am an authorized user on the credit and/or debit card being provided, I agree to the processing of such card, and give BuckDaddys authority to process such payments for the items and quantities indicated above, and in full accordance with the terms of the current Bylaws Agreement in place.

Required*

I am the person listed above and agree to all the terms stated above.

Name

First Last

Authorized Person Submitting Form and Electronically Signing Bylaws Agreement:

Date