Card On File Authorization

Rogue Equine & Companion Animal Clinic accepts most major credit and debit cards. All personal information is kept private. You may cancel this authorization at any time by contacting us in writing. The authorization will remain in effect until cancelled.

  • Please only list the last four digits of your card. This is for confirmation purpose - that we are using the correct card.
  • MM slash DD slash YYYY
  • Reset signature Signature locked. Reset to sign again
    User finger for tablets or phone, mouse if using a PC/Mac.
  • MM slash DD slash YYYY