OCPAW Veterinarian request for payment form

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This form is for reimbursement of the OCPAW voucher for spay/neuter. Please fill it out and an email with your responses will be sent to the email you provided as a receipt for your records.

OCPAW is ONLY responsible for the spay/neuter voucher amount, all other charges are the responsibility of the owner. You will not be reimbursed for any other services rendered over the cost of the voucher.

When we receive the request, a check will be sent to you directly from the bank. This system was developed to streamline payment as you can enter a voucher immediately instead of waiting and sending invoices.

Thank you so much for your continued support of this program.

Please enter the following:

Email *

What is the name of your clinic? *

OCPAW's account number at YOUR clinic must be entered for payment to be sent: *

The voucher number must be entered for payment, we cannot verify the voucher without it. *

Name of owner: *

Name of the pet: *

I have read and accept the legal disclaimer and privacy policy of OCPAW. *

I agree and accept.

Required

A copy of your responses will be emailed to the address you provided.

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