I authorize PETLABS DIAGNOSTIC LABORATORIES INC. to initiate either an electronic debit against my bank account or to charge my credit card according to the terms of the Credit Policy.
I acknowledge that any originating ACH transactions to this account must comply with the provisioning of United States law.
|Billing Contact Name:|
|Billing Contact Phone:|
|Invoice Email Address:|
|Second Invoice Email Address (optional):|
|I prefer to pay via:||Bank Draft from my checking account Credit Card|
|A billing representative from PETLABS DIAGNOSTIC LABORATORIES INC. will contact you to obtain valid payment information.|
This payment authorization will remain in full force and effect until I notify PETLABS DIAGNOSTIC LABORATORIES INC. of its cancellation by sending written notice in such time and such manner that allow both PETLABS DIAGNOSTIC LABORATORIES INC. and the receiving financial institution a reasonable opportunity to act upon it.