Pre-Register Your Horse

Driver's Lic. #

Employer Name, Phone, Address

Spouse's Name

Spouse's Phone

Spouse's Email

Number of Horses*

One

Two

Three

Four

Other

Horse Name (1)

DOB or Age

Sex

Stallion

Gelding

Mare

Breed / Color

Horse Name (2)

DOB or Age

Sex

Stallion

Gelding

Mare

Breed / Color

Horse Name (3)

DOB or Age

Sex

Stallion

Gelding

Mare

Breed / Color

Horse Name (4)

DOB or Age

Sex

Stallion

Gelding

Mare

Breed / Color

Please Indicate Payment Method*

Cash

Personal Check

Credit Card

ScratchPay

Financial Responsibility Agreement

I understand that I am responsible for all charges for the care of my horse(s) provided by Stone Ridge Equine Care. I understand a finance charge of 2.00% monthly, (24% Annual Percentage Rate) will be charged on any past due balance should the account become 30 days delinquent. I understand a $10.00 fee will be assessed for any returned checks and added to the account. I understand and agree to the above terms.
*

I have read, understand and agree to the terms of the Stone Ridge Equine Clinic's Financial Responsibility Agreement listed below.

Pre-Register Your Horse

24-Hour Emergency Equine Service Available

Submit Client Registration Form Online

Driver's Lic. #

Employer Name, Phone, Address

Spouse's Name

Spouse's Phone

Spouse's Email

Horse Information

Number of Horses*

Horse Name (1)

DOB or Age

Sex

Breed / Color

Horse Name (2)

DOB or Age

Sex

Breed / Color

Horse Name (3)

DOB or Age

Sex

Breed / Color

Horse Name (4)

DOB or Age

Sex

Breed / Color

Payment

Payment in FULL is due the day of service for outpatient services. All surgical and intensive care cases require a $500.00 deposit and the balance must be paid in full when the horse goes home.

Please Indicate Payment Method*

Financial Responsibility Agreement

Pre-Register Your Horse

24-Hour Emergency Equine Service Available

Submit Client Registration Form Online

Driver's Lic. #

Employer Name, Phone, Address

Spouse's Name

Spouse's Phone

Spouse's Email

Horse Information

Number of Horses*

Horse Name (1)

DOB or Age

Sex

Breed / Color

Horse Name (2)

DOB or Age

Sex

Breed / Color

Horse Name (3)

DOB or Age

Sex

Breed / Color

Horse Name (4)

DOB or Age

Sex

Breed / Color

Payment Payment in FULL is due the day of service for outpatient services. All surgical and intensive care cases require a $500.00 deposit and the balance must be paid in full when the horse goes home.

Please Indicate Payment Method*

Financial Responsibility Agreement

Payment

Payment in FULL is due the day of service for outpatient services. All surgical and intensive care cases require a $500.00 deposit and the balance must be paid in full when the horse goes home.