Business/Ranch Information

Business/Ranch Name*

Contact Name*

First Last

Phone*

Physical Address (needed for Health and BANGS certificate)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business/Ranch Email Address*

Person Financially Responsible

(If different than listed above)

Name

First Last

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

I understand that my account must be paid in full within 30 days.

I understand

I understand that if my account is unpaid there will be a finance charge of $5.00 or 10% (whichever is greater). This finance charge is automatically applied every month.

I understand

I understand that should I default on payment of my account and collection agency services are required, all costs of collection up to 40% of the balance, including attorney/court costs will be added to the balance of my account.

I understand

I understand that if I am unable to pay for services or products in full at time of service,I must make prior arrangements to settle my account. Payment is due at time of service.

I understand

Large Animal – Client Information & Financial Agreement

Business/Ranch Information

Person Financially Responsible

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