Tack Registration Form

This form is crucial to have on file should your tack be stolen or destroyed.
Circle W Farms will keep your tack's information on file and can provide a signed copy
of it to your insurance company should the need arise. Keep your investment protected.

Full Name: *

Street Address *

City *

State (abbeviate) *

Zip:

Email: *

Phone Number:

Tack Color: *

If other please describe:

Tack Number:

Tack Type: *

Specific Description *

Purchased From: *

Original Date of Purchase:

mm/dd/yyyy

Purchase Price:

Picture of your Item (optional)

By signing this document electronically I certify that all of the above
information is true. Sign & Date in box. *

Once your form has been processed you will receive a copy of our tack registration
form signed and dated by one of our reps. Circle W Farms will also keep a copy of your
registration should the need arise. Questions? Email: circlewfarms@earthlink.net

* = Input is required