Payment and Credit Card Billing Authorization Form

NEW CLIENT INFORMATION

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Card Type
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Please check one of the following:
I hereby authorize TRIANGLE EQUINE MOBILE VETERINARY SERVICES to automatically charge the full balance of my account to my credit card after services are rendered. Furthermore, I agree to notify TRIANGLE EQUINE MOBILE VETERINARY SERVICES of any change to the above before further services are rendered, and I understand that this authority will remain in effect unless cancelled by either party with 30 days notice.
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Office Hours

Monday  

9:00 am - 5:00 pm

Tuesday  

9:00 am - 5:00 pm

Wednesday  

9:00 am - 5:00 pm

Thursday  

9:00 am - 5:00 pm

Friday  

9:00 am - 5:00 pm

Saturday  

Emergencies

By Appt

Sunday  

Emergencies

By Appt