Surrender of Equine Form

Owner Details
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone Number*
Work Phone Number
Email

Consent
I certify that I*
- do own the animal described above.
- do not own the animal described above.
I freely surrender all my interest, if any, therein, to Have a Heart Equine Sanctuary. I request that the horse be disposed of (rehabilitated, rehomed or euthanasia) at the discretion of Have a Heart Equine Sanctuary. I confirm that neither Have a Heart Equine Sanctuary, nor their employees or officials shall incur any obligation to me on account of such disposal of the said animal.
Date*
MM slash DD slash YYYY
Have a Heart Representative*
Surrender Fee Payment Method*
- EFT / Bank Transfer
- Secure card payment via Payfast
Please pay the R800 Surrender Fee to the following account:

Have a Heart Equine Sanctuary
ABSA Bank
ACC NO: 4095653567
BRANCH CODE: 632005
SWIFT CODE: ABSAZAJJ
Cheque Account
EFT / Bank Transfer Proof of Payment*
Max. file size: 32 MB.
Product Name
Total
R0.00
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Have a Heart Equine Sanctuary
Bokdam Plaas, Bonnievale, 6730
NPO 210-005
072 138 5212

Equine Details