PAWS Spay and Neuter Voucher Application 320 East Broadway #2B PO Box 13033 Jackson WY 83002 PH: 307-734-2441 FAX: 866-605-0451 The PAWS Spay/Neuter Voucher Program is made possible by generous donations from individuals in our community. It is a financial assistance program and designed for only those who can prove financial necessity. You will be asked for financial documentation. I acknowledge that I understand what this program offers and for whom it is intended* I understand that this is a financial assistance program and that I will be responsible for coordinating with a local veterinarian to perform the procedure on my pet(s) I understand that veterinarians may have additional costs or fees to perform the procedure, and that I will be responsible for paying those fees at the time of the procedure Pet name, age and gender*Specify if age is months or years ("6 months" or "3 years"). Use the '+' sign on the right side of the row to add additional pets.Pet NameMale or Female?AgeDog or Cat?Breed Your Name:* Mailing Address:* City* State* ZIP Code* Telephone Numbers / Home:*Cell:*Email:* Why are you unable to pay for this procedure?* Where did your pet(s) come from?* Was there a fee to acquire your pet(s)?* Yes No If yes, how much?* Is your pet up to date on all vaccinations?* Yes No Will be at time of surgery Veterinarian:* Have you been a Wyoming/Idaho resident for at least 1 year?* Yes No Which community?* Teton County, WY Teton Valley, ID (incl Swan Valley, ID) Star Valley My annual household income is:* More than $40,000 Less than $40,000 The following items are required and should be uploaded as a JPEG or PDF using the uploader below: Proof of residency: a copy of rental lease, mortgage stub, paycheck, or utility bill that shows your address above. Financial information: a copy of last year’s W2 form, or your most recent two paycheck stubs. It is PAWS’ responsibility to our donors and grantors that PAWS grants financial assistance to those who need it. Once your financial documentation has been reviewed and your situation has been discussed, PAWS reserves the right to award or refuse financial assistance. There may be additional costs at the time of surgery that the pet owner will be responsible for. We urge you to find out all costs associated with surgery while making your appointment. Your signature below states that you accept the terms of this application:Proof of Residency & Financial Information Uploader* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, png, Max. file size: 64 MB. Signature:*
