Pet Wellness Clinics

Annual Protection Plan Membership Renewal


Client Information

First Name:
Last Name:  
Email:


Patient Information

Pet Name:  


Plan Information


Payment Information

Credit Card Number:
Expiration Date:  
CCV: 


I understand that I will be billed for the annual membership fee and first month’s payment today when I check out. I approve my credit card to be billed monthly for the additional 11 monthly payments. I understand that I will be sent home with no more than 6 months of preventative at any given time, each plan is a 12 month, non-cancellable policy, and fees are non-refundable. I understand that prescription preventatives and any medications are unable to be returned, and all services and products are only able to be received during the membership year. (For example: if you fail to pick up your second six months of preventative before the end of your membership year, you will lose that product.) Pet Wellness Clinics are not responsible for overdraft fees associated with my plan. If my payment is not made within 5 days of my normally scheduled payment date, my plan will be terminated and I will be responsible for paying for the unpaid services & products. Unpaid services & products are determined by invoicing used services & products at regular cost and applying credit for the plan’s monthly payments that have been made (credit of monthly payments does not include membership fee). I understand that if my pet has a lapse in heartworm prevention for more than 30 days, I am responsible for updating my pet’s heartworm test at my cost, prior to receiving additional preventatives.


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Pet Wellness Clinics https://www.petwellnessclinics.com
Signature Certificate
Document name: Annual Protection Plan Membership Renewal
Unique Document ID: fbf7ae3b1481a30954a5ecb61fe5e11fdfb901e1
Timestamp Audit
March 26, 2019 2:26 pm EDTAnnual Protection Plan Membership Renewal Uploaded by Elizabeth Smart - info@petwellnessclinics.com IP 96.64.138.9
March 26, 2019 2:34 pm EDTPet Wellness Clinics - chet@thecaway.com added by Elizabeth Smart - info@petwellnessclinics.com as a CC'd Recipient Ip: 45.251.51.89
March 26, 2019 2:41 pm EDTPet Wellness Clinics - info@petwellnessclinics.com added by Elizabeth Smart - info@petwellnessclinics.com as a CC'd Recipient Ip: 45.251.51.89
April 8, 2019 4:49 pm EDTPet Wellness Clinics - info@petwellnessclinics.com added by Elizabeth Smart - info@petwellnessclinics.com as a CC'd Recipient Ip: 182.156.99.44
April 21, 2019 11:54 am EDTPet Wellness Clinics - info@petwellnessclinics.com added by Elizabeth Smart - info@petwellnessclinics.com as a CC'd Recipient Ip: 96.64.138.9