Wellness Plan-Terms and Conditions

 

Wellness Plan: Basic Kitten Wellness Plan

Enrollment Fee: $40.00

Price Per Month: $22.99

 

Basic Kitten Wellness Plan includes the following services:

Examinations Vaccinations Diagnostics

*Physical/Well Exam (Unlimited)

*Distemper Rhinotrach (series)

*Fecal Flotation (2)

*Sick Exam (Unlimited)

*Leukemia (series)

*Microscopic Ear Exam

*Follow Up Exam (Unlimited)

*Bordetella

*Leukemia/FIV Screen

*Dental Exam (1)

*Rabies

*Weight/Food Counseling

 

 

 

Parasite Control Surgical Procedure Boarding/Grooming

*Deworming (2)

*2 nights of boarding in a double condo

*2 Toe Nail Trims

 

 

The enrollment fee and the first month’s payment is due in full today. This agreement is good for 12 months from the start date listed above. Any services not used in the 12 month period are not transferable to the next year and are non-refundable. The contract is effective on the day it is signed, any veterinary services performed before this date are not relevant to this plan.

I understand the services included in the Basic Kitten Wellness Package.

Signature__________________________________

 

 

 

 

Option 1: Automatic Monthly Deduction from Checking/Savings Account

 

ELECTRONIC TRANSFER (ACH) ORIGINATION AGREEMENT

AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)

I (we) hereby authorize Animal Care Center, herinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (out) [ ]Checking [ ]Savings account (select one) indicated below and the depository names below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

 

DEPOSITORY NAME_____________________________________

 

CITY______________________ STATE________ ZIP___________

 

ROUTING NUMBER_______________________ ACCOUNT NO._______________

 

Type of Account:

Checking Account____ Savings Account____

 

 

This authorization is to remain in full force and effect until Company has received written notification from or (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

 

NAME(S)_____________________________________

(Please Print)

 

DATE______ SIGNATURE______________________________

 

(In order to insure the correctness of the Depository information, please attach a voided check (checking) or blank deposit ticket (savings) to this Authorization Form).

 

Option 2: Monthly Charge to Credit Card

Animal Care Center Credit Card Authorization

 

Name_____________________ Date_<date>____Client #<number>

 

Visa, Master card, Discover, Care Credit (circle one)

 

CC #_________________________

 

Exp Date___________________

 

Driver’s License#____________

 

I authorize the Animal Care Center to charge the above credit card $21.95 per month.

 

Signature_______________________________ Date__<date>_________

 

  1. General Terms of Use:

     

    1. This agreement and the services provided under it are not transferable to another Pet or assignable to another person. This agreement applies only to the Pet designated above while owned by client.

       

    2. Any services included in the plan that are not used within the 12 month period are not transferable to the next year and are non-refundable.

       

    3. Client must be 18 years of age

       

    4. Wellness Plans are not insurance

       

    5. Fees for services not included in the wellness plan will be at regular price and must be paid in full at the time the services are rendered.

       

     

Signature_____________________________

 

  1. Exclusions: The following items and services are not included in this Agreement:

     

    1. Services including office visits and consultations rendered by specialists to whom the Pet is referred by Animal Care Center.

       

    2. Services recommended as a result of injury or illness

       

    3. Services at any institution, clinic, or hospital other than Animal Care Center

       

     

Signature__________________________________

 

  1. Payments:

     

    1. Monthly payment installments will be deducted from client’s bank account or charged to client’s credit card on the 5th of each month. If the 5th falls on a weekend or holiday the deduction will be made on the next business day.

       

    2. An overdraft/reprocessing fee of $20.00 will be billed to client for insufficient funds, over limit status or any other reason a payment is unable to be processed based on the account information supplied by client.

       

    3. Client is responsible for immediately notifying Animal Care Center of any changes in billing account information to avoid any payment reprocessing fees.

       

     

 

I authorize the Animal Care Center to charge my checking account or credit card $22.99 per month

Signature_________________________________

 

  1. Automatic Renewal:

     

    1. This Agreement is effective on the Start Date for an initial term of 12 months

       

    2. This plan will automatically renew to the Basic Adult Cat Wellness Plan on the anniversary of the Start Date in each succeeding year for subsequent periods of one year until client or Animal Care Center cancels this Agreement. Monthly payments of $22.99 for the Basic Adult Cat Wellness Plan will continue to be deducted from client’s bank account as well.

       

    3. You will be notified by email or mail prior to the automatic renewal of your plan

       

    4. If you do not want to renew your contract for the next plan year, you must contact us 30 days prior to the end of your contracted plan year. If we do not receive a cancellation notice in writing by that time, your account will be automatically renewed for the following year at the same terms.

       

     

 

Signature_________________________________

 

 

 

 

  1. Default:

     

    1. In the event Client fails to pay any monthly installment within 30 days of its due date, Animal Care Center has the option to immediately cancel this Agreement, discontinue Plan services and declare all services rendered to date be paid in full at retail price.

       

    2. After 30 days, the Client’s account will be referred to a third party collection agency and the wellness plan will not be eligible for reinstatement. Collection activity may negatively impact Client’s Credit Bureau information and is subject to additional collection fees.

       

     

Signature________________________________________

 

  1. Cancellation:

     

    1. Either Client or Animal Care Center may cancel this Agreement at any time, but there may be monies due upon cancellation.

       

     

Cancellation by Client Within 3 business days: If Client cancels this Agreement for any reason within 3 hospital working days of enrollment, the membership fee and any other fees paid are refundable less the undiscounted retail value of any and all services provided.

Cancellation by Client After 3 business days: If Client cancels for any reason (including but not limited to death or loss of Pet or transfer of ownership) before or after Animal Care Center has rendered services the enrollment fee is non-refundable. Animal Care Center will also be entitled to retain or recover from Client all monthly installments that have previously been paid or become due, including the installment for the month in which cancellation occurs, regardless of the cancellation request date. In addition, upon cancellation prior to the end of the Plan Year, if the total undiscounted retail value of Plan services provided exceeds the sum of monthly installments collected for that Plan Year. Member shall be obligated to do one of the following:

 

  1. Immediately pay full retail fees for all services provided (with all discounts reversed as if Plan had not been in effect for the Plan Year) less the total of monthly payments received by Animal Care Center for the Plan Year; OR

     

  2. Immediately pay the total remaining Plan Year monthly installments in full.

     

Cancellation by Provider: Animal Care Center reserves the right to cancel the Plan at any time and for any reason.

Signature____________________________________

 

  1. Plan Upgrades and Downgrades:

     

    1. Client may elect to upgrade or downgrade the level of the current Plan without paying a new membership fee. Upgrades may be made at any time during a Plan Year and will end the existing Plan and create a new Plan at the higher level chosen by the Client. The new Plan will have a new Start Date and will be in effect for a new 12 month term, with automatic renewals on the anniversary of the new Start Date. A new Wellness Plan Agreement will be signed by client for the new plan.

       

    2. Plan downgrades may be elected upon renewal at the beginning of a new Plan Year and will create a new Plan with a new Start Date and a new Plan Year as described above for upgrades. A new Wellness Plan Agreement will be signed by client for the new Plan.

       

     

Signature_______________________________________

 

 

  1. Plan Price and Service Changes:. Animal Care Center reserves the right to adjust monthly fees, services and the terms and conditions of this Agreement as of the date of any renewal of this Agreement. Animal Care Center will give Client notice of any such changes no less than 30 days prior to the date they are to become effective

     

Signature____________________________________