Card Hold Authorization

Rogue Equine & Companion Animal Clinic accepts most major credit and debit cards. All personal information is kept private. This hold authorization may transition to an actual credit card charge under circumstances listed in this form. The authorization will remain in effect until cancelled by us, or by natural expiration under the terms of your credit card provider.

  • Please only list the last four digits of your card. This is for confirmation purpose - that we are using the correct card.
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    MM slash DD slash YYYY
  • You will be advised on the amount to enter and will be held for potential use as noted and agreed upon below. Please read and ask if you have any questions.
  • User finger for tablets or phone, mouse if using a PC/Mac.
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    MM slash DD slash YYYY
  • Please note - the next page will contain a link to store your card securely. Failure to complete this second step will interfere with our ability to provide service. If we already have your card on file, you may ignore the instructions on the next page.