New Client Information Form * required fields Terms of Trade Our terms are strictly cash, unless prior credit arrangements have been made and approved by the New Plymouth Vet Group. If accounts are not paid, we may charge you interest, legal fees and all costs associated with the recovery of any debt. You must be 18 years or over to open an account with us. Proof of age must be required. IdentificationProof of ID*Accepted file types: jpg, pdf, doc, docx, gif, png, Max. file size: 5 MB.We ask to see one form of identification (driving licence, passport, 18+ card etc).Your DetailsFull Name - Mr, Mrs, Miss, Ms, Other*Trading Name (Company) / Known asStreet Address*PostcodePostal Address (If different from above)If a PO Box is given then we must have a physical address.PostcodeTelephone Number*Email* Date of Birth* Day Month Year Secondary Contact or Emergency Contact Name*Secondary Contact or Emergency Contact Number*Relationship*How did you hear about us?Choose OneNewspaperRadioWebsiteFacebookFriendWork ColleagueYellow PagesOtherMonthly Statement Tick this box if you would like to receive your monthly statement via email.Consent - Previous Animal Histories* I give permission for NP Vets to request any animal histories from my previous veterinarian.Previous veterinarian name:*If not applicable please state N/A.Practice phone number:*If not applicable please state N/A.Terms and ConditionsAll credit accounts must be paid in full by the 20th of the month following the date of purchase. Any account remaining unpaid after the due date for payment will incur interest and account fees. New Plymouth Veterinary Group reserves the right to refuse to supply goods or services to any person whose account is unpaid after the due date for payment thereof. The customer is liable for any costs, including legal fees, which are incurred by New Plymouth Veterinary Group for the collection of overdue accounts. Completing this application form does not guarantee a credit account will be opened. Consent* By ticking this box I certify that all information provided is correct and I have read and understand New Plymouth Vets Terms of Trade and Terms and Conditions.Companion Animal - Pet 1Name*Type - Dog/Cat*Breed*Colour*Sex - Male/Female*Choose sexMaleFemaleAge/DOB*De-sexed*Choose oneYesNo Add more animals Companion Animal - Pet 2NameType - Dog/CatBreedColourSex - Male/FemaleChoose sexMaleFemaleAge/DOBDe-sexedChoose oneYesNoCompanion Animal - Pet 3NameType - Dog/CatBreedColourSex - Male/FemaleChoose sexMaleFemaleAge/DOBDe-sexedChoose oneYesNoCommentsThis field is for validation purposes and should be left unchanged. Δ
