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PAWS of JH Spay/Neuter Voucher Online Application

PAWS of JH Spay/Neuter Voucher Online Application

Please enter all required (red asterisk) information

Name * First Last
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Street or PO Box that is verifiable through bills, pay stubs, or other documentation.
Home Phone - ### - ### ####
Please provide a phone number so that we may contact you regarding your application.
Cell Phone * - ### - ### ####
Email Address *
I Need Financial Assistance Because: *
Unemployed/Part-Time Worker Fixed Monthly Income Disability Income Other (Please Explain)
My Annual Household Income *
Less than $40,000 More than $40,000
My Pet is a *
Dog Cat
and is *
Male Female I'm Not Sure
My Pet's Name Is: *
Breed: *
Age: *
Where Did You Get Your Pet ? *
Was There A Fee to Acquire Your Pet ? *
Yes No
How Much Was The Fee ? * $ . Dollars Cents
Please enter a purchase price or adoption fee
Is Your Pet Up-To-Date On All Vaccinations ? *
Yes No I Don't Know
Your Veterinarian
Which Community Do You Reside ? *
Have You Been A Resident For At Least 1 Year ? *
Yes No
With your application, PAWS requires one of the following forms of proof of residency: a lease, a mortgage stub, a pay check, a utility bill or a cell phone bill that shows the address that you listed above.

We require a copy from 1-year ago and one from the current month.

Please use this area to upload a file(s) that contains this info as part of your application.

(jpeg or pdf files only)

Attach Files

On your computer/device, locate the file(s) you wish to use for your application. Click the BROWSE button and navigate to the appropriate location and select your file(s) to upload. If you are unable to complete this step call our office at 307-654-9990 and we will assist you.
PAWS will pay 100% of the cost of the procedure up to the maximum value printed on the voucher. We will also take into account the cost of post-operative pain medication.

PAWS cannot pay additional fees associated with complications from surgery, additional fees for animals in heat, or any separate charges for individual cases.

Payments will be made ONLY to veterinary offices that are participating in this program. Please check with your vet before using a voucher.

Please type your name in the box below and check yes if you accept the terms of this application.

*
I Accept The Terms of This Application *
Yes No
Spam Protection. Please answer this simple question.
7, 8, 9, 10 : the 3rd number is?