CLIENT FORM | baileysequine

Client Information
and Fee Agreement

This agreement is by and between Baileys Equine, Inc and the client named below for veterinary services.
This contract shall apply to any and all services provided and products sold by Baileys Equine, Inc.

First name

Last name

Name on the Account (if different)

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Trainer's Name (Authorizing Agent - This representative is hereby authorized to approve veterinary care to my horse(s) in my absence and I am accepting financial responsibility).

Trainer's Phone Number

Credit Card #

Exact Name on Card

Billing Zip Code

Expiration

Security Code

Terms Of Service

Payment is due upon receipt of invoice.
Should you elect to pay via QuickBooks invoice or by personal/business check, and payment is not received within 30 days of invoice receipt, a late fee of 2% monthly interest and a $25 per month accounting charge will apply.
If paying by check and your check is returned, the client is responsible for all bank charges incurred by Baileys Equine, Inc. and a $25 service fee.

By submitting this form, I am authorizing that services rendered may be charged to the credit card listed above for the current balance due.

Please check this box if you would prefer to recieve a QUICKBOOKS INVOICE sent to your email. If payment for services rendered is not received in full within 30 days of receipt of the invoice, by checking this box you are authorizing Baileys Equine, Inc. to charge the credit card provided above.

Please enter any comments or questions here associated with your new client account.

Your Signature

Select a date

Client Information
and Fee Agreement

This agreement is by and between Baileys Equine, Inc and the client named below for veterinary services.
This contract shall apply to any and all services provided and products sold by Baileys Equine, Inc.

Terms Of Service

Payment is due upon receipt of invoice.

Should you elect to pay via QuickBooks invoice or by personal/business check, and payment is not received within 30 days of invoice receipt, a late fee of 2% monthly interest and a $25 per month accounting charge will apply.

If paying by check and your check is returned, the client is responsible for all bank charges incurred by Baileys Equine, Inc. and a $25 service fee.

Baileys Equine, Inc.
31103 Rancho Viejo Rd, Suite D2030
San Juan Capistrano, CA 92675

Phone: 949-212-2530
Fax: 949-661-1766
manager@baileysequine.com
alisondvm@baileysequine.com

Client Information and Fee Agreement

This agreement is by and between Baileys Equine, Inc and the client named below for veterinary services. This contract shall apply to any and all services provided and products sold by Baileys Equine, Inc.

Terms Of Service

Payment is due upon receipt of invoice.

Should you elect to pay via QuickBooks invoice or by personal/business check, and payment is not received within 30 days of invoice receipt, a late fee of 2% monthly interest and a $25 per month accounting charge will apply.

If paying by check and your check is returned, the client is responsible for all bank charges incurred by Baileys Equine, Inc. and a $25 service fee.

Baileys Equine, Inc. 31103 Rancho Viejo Rd, Suite D2030 San Juan Capistrano, CA 92675

Phone: 949-212-2530 Fax: 949-661-1766 manager@baileysequine.com alisondvm@baileysequine.com

Client Information
and Fee Agreement

This agreement is by and between Baileys Equine, Inc and the client named below for veterinary services.
This contract shall apply to any and all services provided and products sold by Baileys Equine, Inc.

Baileys Equine, Inc.
31103 Rancho Viejo Rd, Suite D2030
San Juan Capistrano, CA 92675

Phone: 949-212-2530
Fax: 949-661-1766
manager@baileysequine.com
alisondvm@baileysequine.com