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Southwest Veterinary Surgical Service, PC

Credit Card Authorization Form

This is the full name of the pet we are caring for
*Billing address must include street, city, state, and zip and must match the billing address on file with the credit card being used.
**Visa, Mastercard, and Discover have a 3 digit code on the back of the card (above the authorized signature area). American Express has a 4 digit code on the front of the card.