This agreement is entered into on the date above by and between High Performance Equine LLC and the client named above (hereinafter “Client”) for veterinary services. This contract shall apply to any and all services provided and products sold by High Performance Equine LLC.
Client Information
Horse Information
Horse #1 (Info Required)
Horse #2 (If Applicable)
Terms of Service
1. Payment is due at the time of service.
2. Clients may elect for automatic payments. If elected, this shall enable High Performance Equine LLC to charge the current balance due at time of service to the credit card stored via PCI Compliance. A receipt will be sent electronically with payment confirmation.
3. If payment for services rendered is not received in full within 30 days of service, Client hereby authorizes High Performance Equine LLC to apply the charges to their credit card on file.
4. High Performance Equine LLC stores credit card numbers in compliance with Payment Card Industry Data Security Standards (PCI DSS). In accordance to regulations, credit card numbers are stored on a firewall and password protected computer, in a financial software program that is also protected by software and complex passwords. As such, Client’s credit card number relating to this agreement shall be submitted on a separate form and deleted immediately after being entered into the secure software.
Client has provided High Performance Equine LLC with a valid credit card number and hereby authorizes High Performance Equine LLC to charge the credit card for services rendered in accordance with the terms of this agreement.
5. Clients may pay by personal or business check. Client is responsible for all bank charges incurred by High Performance Equine LLC if a check is returned, in addition to a $25 (twenty-five dollar) service fee.
6. Unpaid balances may be subject to a 2% monthly interest charge (24% per annum) and a $15.00 (fifteen dollar) per month accounting charge.
7. Unless otherwise requested, all invoices, medical reports and diagnostic images shall be provided electronically.
8. Client must list any agents or representatives that may request and authorize veterinary care or order supplies on behalf of Client. Changes to veterinary agent or representative authorization must be submitted to High Performance Equine LLC by email ([email protected]) and confirmed by High Performance Equine LLC in order to avoid any unauthorized veterinary service charges. High Performance Equine LLC shall not be responsible for verifying current agent or representative authorization.
9. This contract applies to all veterinary services provided by High Performance Equine LLC, to any and all horse(s) on my behalf, whether or not the horse(s) are listed on this form.
10. High Performance Equine LLC has the right to refuse service at any time. High Performance Equine LLC will not guarantee service to Clients with accounts that are past-due beyond 30 days.
11. Client shall immediately notify High Performance Equine LLC if he/she is unable to comply with the terms of this agreement. High Performance Equine LLC reserves the right to waive fees and modify payment deadlines on an individual, case-by-case basis at its sole discretion. Such an agreement shall be effective upon the execution of a separate, written agreement, signed by both parties.
12. Except as otherwise provided in this document, this agreement may be modified, superseded, or voided only upon the written and signed agreement of High Performance Equine LLC and
Client. Further, the physical destruction or loss of this document shall not be construed as a modification or termination of the agreement contained herein.
12. The rights and obligations of the Parties under this Agreement shall be governed by the internal substantive law of the State of Virginia applicable to contracts made and to be performed in that State, without giving effect to the principles of conflicts of laws. For the purpose of jurisdiction and venue for all purposes of this Agreement shall be Loudoun County, Virginia. If any legal action, arbitration or other proceeding is brought for the enforcement of the agreement, or arises out of an alleged dispute, breach, default or misrepresentation relating to any of the terms of the agreement, the prevailing party shall be entitled to recover reasonable attorneys fees and other costs in that action or proceeding in addition to any other relief to which it may be entitled.
Relationship Guidelines
We are honored to be a part of your horse’s care team and are committed to providing you with state-of-the-art healthcare tailored to your individual needs. We are keenly aware of the time and money you dedicate to your horse and are fully committed to helping you reach your goals with them. A mutually respectful relationship is imperative for us to meet these goals. We kindly ask that you follow and respect the following guidelines:
- High Performance Equine LLC is an elective sports medicine veterinary service provider. Appointments are available Monday through Friday while based in Virginia, and Tuesday through Sunday while based in Florida
- All members of our team are integral to the care of your horse and should be treated with respect
- Please limit communications to workdays during normal business hours of 9am – 5pm
I, the undersigned, have read, understood, and agreed to the above information.
