Buying Group Membership Form

Buying Group Membership Form
I/We wish to share the benefits of the MWI Animal Health Group. I / we would like to join the group from 1st of the month.

I / We agree to ensure that sufficient funds are always available on the 20th monthly for the Group to debit my / our account for the full cost of my / our purchases including the Administration Fee, so that the Group may pay the Wholesaler and others on my / our behalf.

Should I / we wish to withdraw from the Group, I / we understand that I / we can do so at the end of any month upon written confirmation.
Primary Contact Name
Practice Name
Address

Address 1

Address 2

CityCounty

Postcode
Telephone

Area CodePhone Number
Fax
Email
Please tick how you would like to be contacted for newsletters and marketing materials. By ticking the boxes below, you are providing consent to being contacted.

EmailBy Phone
Please tick the services in which you are interested in

Inventory ManagementBusiness AcademyOffice SuppliesInstrument Care LaboratoryCapital Equipment ConsultationPet Health PlansLaboratories & Pet CremationPet InsuranceHR ServicesHealth & Safety ServicesFinancial & Insurance ServicesAutoclavs Servicing and ValidationMerchant Services and Payment ProcessingUtilities, Waste Management & Ancillary ServicesOther
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