Final Contract Form - Wichita Animal Action League

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.

Reference Document Number:*
(from invoice or quote reference)
Contract entered into by:*
(Name of second party)
First Last
The Second Party agrees that he/she/they shall :*
Terms of Contract begin:*
MM slash DD slash YYYY
Total Loan Amount:*
Payment Due Date:*
MM slash DD slash YYYY
First Monthly Payment Amount :*
WAAL agrees that it shall :*
WAAL Signature
WAAL Print Name
First Last
WAAL Address
Street Address City State / Province / Region ZIP / Postal Code
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.
Signature*
Date*
MM slash DD slash YYYY
Print Name
First Last
Pet Owner's Address*
Street Address City State ZIP Code
Phone Number*
Hidden
Email
Driver's License #*
State of Registered License:*
State
*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. You may submit payment on our website at www.waalrescue.org/donate AND immediately email [email protected] to notify her of payment amount.

Vet Assistance Final Contract

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.