Large Animal – Client Info & Financial Agreement

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Large Animal – Client Info & Financial Agreement

Business/Ranch Information

Business/Ranch Name *

Contact Name *

First

Last

Phone *

Physical Address (needed for Health and BANGS certificate) *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Business/Ranch Email Address *

Person Financially Responsible

(If different than listed above)

Name

First

Last

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

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

Signature *

Clear Signature

Payment is due at the time of service and this form must be complete

Date *

We proudly serve the pets of Wolf Point and beyond.

Our philosophy is to provide excellent customer service and first rate pet care. We strive to create a relaxing-friendly environment for you and your pet. Our clinic is comfortable, pet-friendly, and calm.

Large Animal – Client Info & Financial Agreement

Large Animal – Client Info & Financial Agreement

Business/Ranch Information

Person Financially Responsible

We proudly serve the pets of Wolf Point and beyond.

CONTACT US!

Phone

email

address

HOUR OF OPERATIONS

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