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Enrollment Type
 
New Membership:
   
Renewal:
   
       
Owner's Information
       
Today's Date:
format dd:mm:yyyy    
Owner's Name:
first and last name
Other Responsible Party:
first and last name
           
Home Address
           
Street Address:
   
City:
State
     
ZIP:
       
           
CONTACT INFORMATION
 
Area Code:
Phone #
     
Area Code:
Cell #
     
           
E Mail:
       
 
Choose Your Provider
 
Veterinarian Office::
Referred By:
   
         
         
           
           

 

 
Pet Information
                     
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
Name:
Breed:
Sex:
Color:
Type:
Age:
                     
 
Submit Application and Plan Payment
Submit Your Application to American Pet Care Plan  
Once you submit this application to American Pet Care Plan you will be taken to the payment center with instructions on submitting your secured payment through PayPal.
Coverage is effective immediately once payment is made. Please allow 3-4 weeks for receipt of membership card. Print application and PayPal confirmation to use as proof until membership card is received.
"American Pet Care Plan is NOT an insurance plan, but merely a membership plan that allows for discounts on veterinary care. Discounts and any savings associated with the plan MUST be given by a participating provider at the time of service. There will be no reimbursements from American Pet Care Plan for services provided by any veterinarian or pharmacy."