Talon

Please confirm that you and your pet are currently registered clients of Abbeywell Veterinary Clinic

Yes, my pet is currently registered with Abbeywell Veterinary Clinic

No, my pet is NOT currently registered with Abbeywell Veterinary Clinic

We are sorry you are not registered with Abbeywell Veterinary Clinic

Our Health Plan is exclusive to pets and their owners who are registered with Abbeywell Veterinary Clinic.
Please see our website for more information about how to register your pet.

Please confirm that your pet is micro-chipped

Yes, my pet is micro-chipped

No, my pet is NOT micro-chipped

Please contact the surgery on 01303 227179 to arrange an appointment for your pet to have their Microchip.

Pet Owner Details

Title

First Name

Middle Name

Last Name

Client PMS Reference

Phone

Email

Pet Owner Address

Address 1

Address 2

City

County

Postcode

Country

The Pet lives at the same address

Pet's Address

Address 1

Address 2

City

County

Postcode

Country

Pets Details

Direct Debit Payment Details

Name on the account

Account Number

Sort Code

The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
If there are any changes to the amount, date or frequency of your Direct Debit Merlin Simple Payment Solutions Ltd will notify you 7 working days in advance of your account being debited or as otherwise agreed. If you request Merlin Simple Payment Solutions Ltd to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
If an error is made in the payment of your Direct Debit, by Merlin Simple Payment Solutions Ltd or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when Merlin Simple Payment Solutions Ltd asks you to.
You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us at office@merinsps.co.uk

Confirmation

I understand that this is NOT an insurance policy

I read the Terms and Conditions of the agreement

I am the account holder & the only person required to authorise Direct Debit payments on this account