Vet Assistance Final Contract

Please fill out the form below. Your application cannot be considered complete until you have completed and submitted this final contract form. Please note that this contract sets up your repayment plan for vet assistance.

  • (from invoice or quote reference)
  • (Name of second party)
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • WAAL Signature
  • This contract may not be modified in any manner unless in writing and signed by WAAL and the Second Party. This contract shall be binding upon the parties and shall be enforced under the law of the State of Kansas.

  • MM slash DD slash YYYY
  • Hidden
  • *Repayment Options

    1. You may submit a payment via check Phone Number to our PO Box 21401 Wichita, KS 67208 and write your pet’s name and “Vet Repayment” in the memo line.
    2. OR
    3. You may submit payment on our website at AND immediately email [email protected] to notify her of payment amount.