Rescue Bank Application - Rescue Groups

The GOODS Program - Rescues

Organization

Organization Type

Federal ID #

Proof of Non-Profit Status - IRS Determination Letter

Upload File

Website Address

Website link to adoptable animals, Do not put the word "Petfinder" or petfinder.com

Primary Contact Name

Applicant's Position in Organization

Phone Number

Street Address (No PO Boxes)

City

State

Zip Code

Number of active volunteers

Number of employees

Animals Reside In:

Spay/Neuter all animals prior to adoption?

If no, explain why

# cats adopted past 12 months

# dogs adopted past 12 months

Average monthly need for cat food (lbs)

Average monthly need for dog food (lbs)

Mission Statement

Describe Adoption Program

Does your organization have a contract to provide animal control services for any city, county, or municipality? If yes, please explain.

Veterinary Reference - Name, Phone Number, Contact Person, Address

Have you participated in a "donated" or "low cost" pet food program within the past 12 months?

If yes, please provide program name and frequency.

Why are you requesting support from Rescue Bank?

How did you hear about our program?

Reference 1: Name, Phone Number, and Relation to Group

Reference 2: Name, Phone Number, and Relation to Group

Interview Times

I have read and agree to the Terms and Conditions. (Will open a new window.)

Signature

Date