Application for Credit

To be completed by the applicant. At this time we only offer this service to residents of Canterbury New Zealand.

Contact Details

Name of Applicant *

First

Last

Email *

Primary phone number *

Phone number (alternate)

Address

Street name and number *

Suburb *

Treatment Details

Authorisation number *

Veterinary clinic *

I consent to CPL being sent my vet notes/records *

Estimated cost of treatment *

Amount to be paid by Applicant at time of treatment *

Repayment Details

I can pay *

Per *

Payment method *

I will make payments at the office of CPL at 14 Charlesworth Street, Woolston, Christchurch. (Open 10am to 4pm weekdays)
I will make payments via online banking/automatic payment to CPL's bank account BNZ 02-0842-0003160-00

My payments will commence on *

Declaration

Any applicants who default on payments may be referred to a debt collection agency and any costs incurred will be added to the amount owing.Your contact details and other information are retained solely by the Cats Protection League. Your information is confidential and only accessed by Cats Protection League staff or may be released if required by law. You may check, update and request suppression of your details from our records by contacting the Secretary.

By ticking this box I agree that the information I have provided is true and that I agree to the terms listed above *

I agree