Direct payment registration form

In order to optimize our services and for ecological purposes, we want to include you in our list of electronical direct payment. Please fill this form.

Business Information

Secret code provided by Vetoquinol

This code is provided to Veterinary Clinics only.

Company Identification Number

The 9-digit business number (BN) assigned by the Canada Revenue Agency (CRA) to identify a business, incorporated company or society.

Business name

Business address

(civic number, street, city, province, postal code - a PO Box is not acceptable and the wire transfer will not be authorized)

Phone number

Email where the payment remittance will be sent

Contact person

Banking information

For a visual reference on your fincial institution information, click here.

Name of Beneficiary

Financial institution

Address of financial institution

(civic number, street, city, province, postal code)

Institution number

Institution ID number (transit or branch) *

Account or folio number

Swift Code

You can find it online using Google: "swift code [name of your financial institution]"

Business cheque specimen or letter from you bank

One file only.
50 MB limit.
Allowed types: jpg, png, pdf, jpeg.

Authorization

I hereby authorize Vétoquinol N.-A. inc. to pay for purchases/services through direct deposit in the bank account above. I will notify Vetoquinol of any changes to this form. I understand that this authorization will remain in effect until an authorized signee submits a written cancellation request.

Name of authorized signee

Title