New Client Information Form * required fields Terms of Trade Our terms are strictly cash, unless prior credit arrangements have been made with the Vet Group. If accounts are not paid, we may charge you interest, legal fees and all costs associated with the recovery of any debt. IdentificationProof of IDAccepted file types: jpg, pdf, doc, docx, gif, png, Max. file size: 5 MB.We ask to see one form of identification (driving licence, electricity bill, bankcard etc).Your DetailsFull Name - Mr, Mrs, Miss, Ms* Trading Name (Company) / Known as Street Address*Postcode Postal Address (If different from above)If a PO Box is given then we must have a physical address.Postcode Telephone Number* Email Date of Birth* Day Month Year Secondary or Emergency Contact Name* Secondary or Emergency Contact Number* How did you hear about us?Choose OneNewspaperRadioWebsiteFacebookFriendWork ColleagueYellow PagesOtherPromotional Materials Tick this box if you do not wish to receive any promotional material via email.Monthly Statement Tick this box if you would like to receive your monthly statement via email.Consent - Previous Animal Histories* I give permission for NP Vets to request any animal histories from my previous veterinarian.Previous veterinarian name and contact number:*If not applicable please state N/A.Terms and ConditionsAll credit accounts must be paid in full by the 20th of the month following the date of purchase. Any account remaining unpaid after the due date for payment will incur interest and account fees. New Plymouth Veterinary Group reserves the right to refuse to supply goods or services to any person whose account is unpaid after the due date for payment thereof. The customer is liable for any costs, including legal fees, which are incurred by New Plymouth Veterinary Group for the collection of overdue accounts. Completing this application form does not guarantee a credit account will be opened. I certify my contact details entered above are correct and I agree to the Terms of Trade listed above.Consent* I agree to NP Vets Terms and Conditions.Companion Animal - Pet 1Name Type - Dog/Cat Breed Colour Sex - Male/FemaleChoose sexMaleFemaleAge/DOB De-sexedChoose oneYesNo Add more animals Companion Animal - Pet 2Name Type - Dog/Cat Breed Colour Sex - Male/FemaleChoose sexMaleFemaleAge/DOB De-sexedChoose oneYesNoCompanion Animal - Pet 3Name Type - Dog/Cat Breed Colour Sex - Male/FemaleChoose sexMaleFemaleAge/DOB De-sexedChoose oneYesNoCommentsThis field is for validation purposes and should be left unchanged.