REVS New Client Form

Client Information*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please select ONE of our 2 invoicing options:

Invoices delivered by email with monthly statementAuto Pay: Invoices are delivered by email and credit card will be charged automatically bi-weekly, followed by a statement which will display payment. If this option is selected, the office will contact you to gather credit card information

If Auto Pay is not your preferred option, payments can be made via e-transfer to rivendellequine@gmail.com, credit card, cash or cheque.

If paying by credit card, payment can be made directly through our website. Check out rivendellequine.com > Forms > REVS Payment Form.

Note: please check your spam folder for invoices/statements

Name of regular veterinarian*

Please provide name of DVM or practice.