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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Cardholder Information' section. Enter your name as it appears on the credit card, select the card type (Visa, MasterCard, Amex, or Discover), and specify whether it's an individual or corporate account.
Provide your account number, expiration date, and security code (the last three digits on the back of your card). Ensure that you also enter your billing address, including city, state, and zip code.
In the 'Approved Charges' section, indicate the balance due for services previously rendered and any other payment amounts if applicable. Clearly state if this card will be used for future charges.
Finally, review all information for accuracy. Sign and date the form in the designated areas to authorize Cedar Veterinary Hospital to process payments as indicated.
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