PAWS Spay and Neuter Voucher Application 320 East Broadway #2B PO Box 13033 Jackson WY 83002 PH: 307-734-2441 FAX: 866-605-0451The Ira Peterson spay/neuter program is funded by generous donations and PetSmart Charities. If your annual household income is less than $40,000, we will fully fund the spay/neuter surgery. If you make more than $40,000 and you need assistance, you can purchase a voucher for $20 (cat) or $35 (dog) which is a significant savings. You can use this form to submit an application for multiple pets. Use the '+' sign on the right side of the row to add additional pets.Pet name, age and gender*Pet NameMale or Female?AgeDog or Cat?Breed 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.Your Name:*Mailing Address:*City*State*ZIP Code*Telephone Numbers / Home:*Cell:*Email:* Why are you unable to pay for this procedure?*My annual household income is:*More than $40,000Less than $40,000Are you willing to show PAWS documentation regarding your annual income?*YesNoWhere did your pet(s) come from?*Was there a fee to acquire your pet(s)?*YesNoIf yes, how much?*Is your pet up to date on all vaccinations?*YesNoVeterinarian:*Have you been a Wyoming/Idaho resident for at least 1 year?*YesNoWhich community?*Teton County, WYTeton Valley, ID (incl Swan Valley, ID)Star ValleyWith your application, PAWS requires one of the following forms of proof of residency: lease, mortgage stub, paycheck, utility bill or a cell phone bill that shows the address that you listed above. If you live in Teton County, we need to see proof of residency from one year ago as well. PAWS will pay 100% of the cost of the procedure up to the maximum value printed on the voucher. We will take into account 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. Your signature below states that you accept the terms of this application and by typing your name below, you indicate that all of the above is true and that you agree to the terms:Proof of Residency: Drop files here or Accepted file types: jpg, jpeg, pdf, png. Signature:* This iframe contains the logic required to handle Ajax powered Gravity Forms.