Name* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone #* Cell #* Work #* Email* Would you like to receive your bills via email? Yes No Barn Manager Name Barn Manager Phone # Is your barn manager authorized to schedule appointments?YesNoFarrier Name Farrier Phone # Barn Gatecode Barn Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Horse's Registered Name Horse's Barn Name Breed DOB/ Age Sex Color Payment Policy: Payment in full is due at the time services are rendered. A valid credit card can be kept on file. Client is responsible for updating credit card information on file. Client authorizes and acknowledges receipt of services and/or medications rendered. Unpaid balances will be subject to finance charges of 1.5% per month. Any costs incurred as a result of non-payment of any bills, including interest, attorney's fees and court costs will be sustained by the client. I have read, understand and agree to the terms contained herein:EmailThis field is for validation purposes and should be left unchanged.
