Free Veterinary Payment Plan Template
Veterinary Payment Plan
This payment plan agreement outlines the terms and conditions for payment arrangements related to veterinary services provided by [YOUR COMPANY NAME]. By signing below, the client agrees to the terms of this plan.
I. Client Information
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Client Name: Jake Willms
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Pet’s Name: Fluffy
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Address: Arlington, TX 76001
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Phone Number: 222 555 7777
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Email Address: jake@you.mail
II. Veterinary Services Provided
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Date of Service: June 15, 2077
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Description of Services:
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Consultation Fee: $50.00
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Diagnostic Test: $120.00
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Medication: $30.00
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Surgery: $450.00
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Other Services: $100.00
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Total Amount Due: $750.00
III. Payment Plan Details
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Down Payment: $150.00 due upon signing of the agreement.
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Installment Amount: $100.00 to be paid monthly.
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Number of Installments: 6 monthly payments.
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Payment Due Date: Payments will be due on the 1st day of each month.
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Final Payment Date: December 1, 2077.
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Payment Methods Accepted: Credit Card, Debit Card, Bank Transfer, or Check.
IV. Terms and Conditions
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Late Fees: A late fee of $25.00 will be applied if a payment is not received within 7 days of the due date.
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Early Payment Option: Clients may pay off the balance early without any penalty. Payments should be made to the same account number provided above.
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Account Default: Failure to make the scheduled payments may result in collection proceedings. If the account is turned over to collections, the client will be responsible for any additional fees incurred.
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Refund Policy: No refunds are provided once services have been rendered. If the client wishes to dispute charges, they must notify [YOUR COMPANY NAME] within 30 days of the service date.
V. Agreement Acknowledgment
By signing below, the client acknowledges that they have read and agreed to the terms of this Veterinary Payment Plan.
Client Signature:
Date: June 15, 2077
Veterinary Practice Representative:
Date: June 15, 2077
