Farm Insurance
Services
I hereby authorize Stohlman Stock Solutions (SSS) to provide routine and emergency care to my animal upon my request or upon the request of an authorized agent upon my absences.
I authorize the use of appropriate sedation and/or other medication(s) and I understand that Stohlman Stock Solutions personnel will be utilized as deemed necessary by the attending veterinarian (please initial).
Payment/Credit Policy
  • Payment by cash, check, Visa, Mastercard, Discover, American Express, Care Credit, direct withdrawal (ACH), or Venmo is expected and due at time of service.
  • A 5% discount will be applied to payments made with cash, check, or direct withdrawal (ACH), at the time of service.
  • If you are absent during the appointment, arrangements must be made to remit payment. If payment is not received at the time of service, you may be denied current and/or future services.
  • New services cannot be provided, and appointments cannot be made if there is an overdue balance. Invoices that are not paid at the time of service are automatically overdue.
  • Returned checks: a fee of $45 will be applied for any returned checks. Docusign Envelope ID: 1DAFE958-984B-472D-A384-7293F6AD0C53
  • All balances not paid in full will incur a finance charge at the highest level permitted by Indiana law (currently 21% annually). Finance charges will be assessed monthly.
  • Client agrees to pay all costs incurred with collection of debt, any court cost, and/or reasonable attorney fees.
Sign above
Credit Card Information
All clients have the option to have credit card or direct withdrawal information on file. To put a credit card or direct withdrawal information on file, please fill out the information below. If you would prefer to do it over the phone, please call the office on (877) 499-9909. Your signature is required below, even if you provide your information over the phone. This card will be charged after services are provided, unless other arrangements are made.
Sign above
Direct withdrawal (ACH) Information
If you prefer not to leave a credit card on file and choose direct withdrawal from your bank account, please fill out the information below. ACH payments made at time of service receive a 5% discount.
Type of Account
Sign above
example of check
We believe that effective communication of fees and payment policy is vital to maintaining a good working relationship. If you have any questions or concerns, please bring it to our attention.
CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.