A Sample Practice – Premier Vet Alliance

Thank you for joining our Premier Pet Care Plan, a great way to spread the cost of treatments and give your pet the preventative healthcare they deserve.

We offer great savings, and the cost of products and services included in the plan are split into convenient monthly payments.

If your pet is over 6 months old you can also have your products delivered to your home. Just tick the HomeDelivery option on the next page to choose one of our Home Delivery plans.

There is a one-time membership fee of $50 taken with your first payment.

Please contact us on 1234 56789 for more details on our plans, or click on the links below.

Cat Plan – $40
Small Dog Plan – $50

Pet Details

Pet name*

Date of Birth*

If you don’t know your pet’s age, please provide a considered estimate.

Gender*

Female
Male

If your pet is under one year of age, please select a plan that reflects your pet’s estimated adult weight.

Please note that Home Delivery options are not available for pets younger than 6 months.

I would like my products delivered to my home after my initial vet visit.

Please select the correct plan below

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Check the pet details below and click proceed.

Pet Owner Details

I already have a pet on plan, find my details

First name*

Last name*

Zip code*

Email address or Existing pet plan pet name*

OR

I am new to pet plans

Title*

First name*

Last name*

Phone*

Email address*

Address Line 1*

Address Line 2

City*

State*

Zip code*

Payment Details and Payment Collection Schedule

Please choose your draft date for your reoccurring payments to be taken, and add your payment account details. If you have an ACH (checking/savings) account, we will attempt this account first, and will use any additional credit or debit card as a backup payment option.

Payment Schedule

The first payment to activate your pet plan(s) will be taken after the confirmation page.

Regular monthly payment on

* of the month.

Payment Details validation

Confirm details

Your first payment, including the one-time membership fee, will be taken after confirmation and will activate your plan. Regular payments will be taken on your chosen payment day starting from the following month.

Please confirm the following details are correct.

Pets

Your details

First Collection(s) to be charged today

I have read and understand the terms & conditions of this agreement I can confirm that I am the account holder and the only person required to authorize payments on this account I understand upon submission of this agreement, the first payment fees outlined above will be debited from my account

Thank you

Thank you!

What’s next?

Your pet is now a member of A Sample Practice’s Pet Care Plan.

A confirmation email with your plan enrollment details will be sent to the email provided.

If you have an appointment booked, we look forward to seeing you soon.

If you need to book an appointment, please contact us.

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