Owner Name *

First Name

Last Name

Owner Phone *

(###)

###

####

Veterinarian Name *

First Name

Last Name

Cell/Work Phone *

(###)

###

####

OWNER’S AUTHORIZATION: *

In case of emergency, and if unable to contact me (the Horse Owner), I authorize Aubrey Meadows, LLC to act on my behalf in contacting the veterinarian noted above to care for my horse. I agree to pay for all expenses and services incurred. By checking the box below I agree to the terms stated.

Yes I agree the terms above.

Name *

First Name

Last Name

ONLINE SIGNATURE *

By clicking the box below I acknowledge that this represents my legal signature in acceptance of all terms of the agreement shown above.

YES, I accept all terms.

Phone *

(###)

###

####

Signature Date *

MM

DD

YYYY

Main Onsite Contact Name *

First Name

Last Name

Relationship to Horse *

Owner

Rider

Trainer

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vet Name

First Name

Last Name

Phone

(###)

###

####

Contact Name #1 *

First Name

Last Name

Phone *

(###)

###

####

Contact Name #2

First Name

Last Name

Phone

(###)

###

####

Contact Name #3

First Name

Last Name

Phone

(###)

###

####

Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

HAY (per bale) & SHAVINGS (per bag) *

Please select all that apply and provide quantities below.

PURE ALFALFA

BERMUDA

ORCHARD

TIMOTHY

TEFF

SHAVINGS

Signature *

By checking the box below I agree that this represents my signature for online documents and orders.

Yes, this is my signature.