Select the Southwest Veterinary Surgical Service location where payment will be processed GilbertGlendaleScottsdaleTucson
Patient Name associated with Southwest Veterinary Surgical Service
*Credit Card Billing Address:
Type of Card: VisaMastercardDiscoverAMEX
I authorize Southwest Veterinary Surgical Service, PC to charge my credit card for veterinary services provided for my pet.
I understand that I am giving the above named practices(s) permission to charge my credit card without my signature on the charge slip.
* 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.