Twin Ports Equine 247 Erickson Rd. Esko, MN 55733
Total Value of Services Provided $256.50
Wellness Program 2013 Enrollment Form
Enrollment form and payment in full is due by February 15th. Farm call charges are included in the program. Optional services that are offered at a discount will be billed separately at the time of service. An additional discount is available for owners with 4 or more horses enrolled. A prorated refund for services that have not been delivered will be given if an enrolled horse is sold or moves out of the area.
Total Cost of Wellness Program $199.00 (1-3 horses)
$179.00 (4 or more)
Includes 10% discount on optional vaccinations, routine dental work, sheath cleaning, and an equine comprehensive blood panel.
Owners Name__________________________________ Email ______________________
Phone Home_____________ Work _______________ Cell____________________
Breed________ Color________ Sex________ Age____ Stable Name_______________
Wellness Program $199.00 Number of horses_____
Circle one: Check enclosed Visa Mastercard
Name on card_____________________________________ Expiration ____________
Signature_________________________________________ Date ________________