Get Kansas State Vet Lab

The Kansas State Veterinary Diagnostic Laboratory offers an online credit card authorization form for users to facilitate secure payments. This guide will provide step-by-step instructions for effectively completing the form to ensure a smooth submission process.

Follow the steps to complete the online credit card authorization form

1. Press the ‘Get Form’ button to access the credit card authorization form and open the document in your preferred online editor.
2. Enter today’s date in the designated field.
3. Fill in your clinic name to identify the submitting entity.
4. Provide the name on the credit card being used for the transaction.
5. Complete the address section with the billing address associated with the credit card.
6. Input the corresponding city, state, and zip code.
7. Specify the country of the billing address.
8. Enter a contact phone number.
9. If applicable, submit a fax number for correspondence.
10. Input a valid email address for transaction confirmations.
11. Fill in the account number related to the submission, if available.
12. Provide the invoice number associated with the transaction.
13. Enter the accession number, if applicable.
14. Input the animal ID or microchip number for identification purposes.
15. Describe the charge you are requesting the payment for.
16. Indicate the type of card used — select one option: VISA, MasterCard, Discover, or American Express.
17. Specify the amount for the transaction in dollars.
18. Enter the credit card number to be charged.
19. Provide the expiration date of the card in MM/YYYY format.
20. Sign the form to authorize the transaction, ensuring that the clinic is aware they are responsible for any declined payments.
21. Indicate whether a receipt is required by checking the appropriate box and specify the method of receipt: fax, mail, or email.
22. If the payment is an international charge, contact your credit card company for preauthorization.
23. Review all entries for accuracy, then save your changes, download, and print or share the completed form as needed.

Complete your forms securely online to streamline your payment processes.