NOTE:  ONLY VETERINARIAN SERVICES AND/OR PET 
MEDICATIONS ARE AUTHORIZED CHARGES TO THIS CARD
Your Cat's Name: 
Veterinary Treatment Authorization 
To whom it may concern: In the event of an emergency, by my signature on the Tampa Cat Lady Service Contract, I authorize the veterinarian listed below to medically treat my animal(s). I will be fully responsible for all fees or charges incurred on my behalf. If my preferred veterinarian is not available, I authorize Tampa Cat Lady to use the services of any available veterinarian.
Preferred Veterinarian Name
If you have not made payment arrangements, we will attempt to contact to you so you may authorize 
the charges with the vet. If you cannot be reached, Tampa Cat Lady will  use this charge card information 
for medical billing:               
For Security Purposes,    
do not list your last name   
Name on Credit Card  -- First Name:                            Middle Initial:  
Credit Card Number:
 Security Code:     
(4-digit on front of American Express;   
3-digit on back of other cards)
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OPTIONAL VETERINARIAN PAYMENT INFORMATION    
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Maximum  Charge Authorized  $     
Pet Sitting Services Tampa Pet Sitting Services Pasco Pet Sitting Services Wesley Chapel
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Type:    
Tampa Cat Lady does not require your charge card information. If you have not made payment arrangements with your vet you may prefer that we have this information on hand for your own peace of mind

The 'Veterinarian Payment Form'  is filed in a secure location and identified only by your cat's name. If a 
veterinary need arises, we will attempt to contact you so you may authorize the charges with the vet. 

If you cannot be reached, we will use the charge card information you provide below.   
Expires:  
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2007-2017