Spay & Neuter Voucher Application

P.O. Box 5084
Cabot, AR 72023

www.aaharescue.com

https://www.facebook.com/ArkansansAssistingHomelessAnimals/
Spay & Neuter Voucher Application

Lonoke & Prairie County Residents Only
PLEASE NOTE THAT WE ARE A VOLUNTEER-RUN ORGANIZATION. WHEN APPLYING FOR A VOUCHER, PLEASE NOTE THAT YOU WILL NOT RECEIVE APPROVAL IMMEDIATELY. VOUCHERS ARE TYPICALLY APPROVED ONCE A MONTH (AROUND THE 15TH-20TH) MEANING YOU LIKELY WON'T GET IT PRIOR TO YOUR APPOINTMENT IF IT IS SCHEDULED WITHIN A FEW DAYS.

WE ARE JUST LIKE YOU AND HAVE FAMILIES, FULL-TIME JOBS, AND PRIOR COMMITMENTS OUTSIDE OF RESCUE. PLEASE BE CONSIDERATE AND UNDERSTANDING OF OUR TIME. THANK YOU.
PLEASE ONLY SUBMIT ONE PET PER APPLICATION. APPLICATIONS WITH MORE THAN ONE PETS NAME LISTED WILL BE DENIED. IF YOU HAVE ANY QUESTIONS, PLEASE EMAIL US AT aaha.speuterteam@gmail.com.
Participating Clinics:
Cabot Animal Shelter (Cabot) 501.843.2021
Arkansans for Animals (Little Rock) 501.455.5400
Companions Spay & Neuter (Greenbrier) 501.679.7900
Grand Prairie Veterinary Services (Hazen) 870.255.0022
Jacksonville Animal Hospital (Jacksonville) 501.982.2581
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
How many of the following currently reside in your home:
Adults (18 years of age or older)*
Children (Birth to 17 years of age)*
Dogs*
Cats*
Other pets*
Under $30,000$30,000 - $50,000$50,000 - $75,000$75,000 - $100,000Over $100,000
Please attach a copy of your most recent pay stub or W-2. Submissions must be clear and legible showing the applicant's name and income or the voucher will be denied. The attached documents will be used to verify income. Without proof of income, your application will not be reviewed. If you have no income but are on EBT, please submit a photo of your benefits sheet or your actual EBT card. If you are on SSI, please submit a benefits statement.
Proof of Income Upload*

Browse Files

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Proof of Residency Upload*

Browse Files

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Animal for which you are seeking to spay/neuter:
DogCat
Name of animal (not YOUR name)*
Age of animal*
Breed of animal (For cats list long, short, or medium haired)*
Color*
Weight of animal (estimate)*
MaleFemale
***THE VOUCHER WILL MOST LIKELY END UP IN YOUR SPAM FOLDER!!! PLEASE CHECK YOUR FOLDER FREQUENTLY FOR A RESPONSE!!!***
I swear/affirm that these answers are true and correct to the best of my knowledge.
Signature

Clear
The voucher may be used at a participating vet, has no cash value, and is not transferable.

This voucher was funded by a grant from Arkansas Animal Rescue Foundation (AARF)
Should be Empty: