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Name & Phone of authorized person within the organization who can verify your status:
________________________________________________________________________
Name your medical records are to be kept under:
________________________________________________________________________
How many years experience do you have in shelter/rescue work:
________________________________________________________________________
How many animals do you handle in an average month:
________________________________________________________________________
Payment is due when services are rendered. In order to avoid a price increase, we have discontinued running open accounts and 3rd party billing. Please arrange to make payment at the time of service.
Signature: _______________________________________________________________
Date: ___________________________________________________________________
Private owners and caretakers are not eligible for rescue prices. Rescue prices do not apply post-adoptionif we are dealing with the new owner, not to members of the general public try to deal with a one-time situation.
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