VIPP Financial Assistance

VIPP Financial Assistance

Requests for financial assistance need to be approved prior to receipt of services.
Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number*

Area Code Phone Number
Email*
example@example.com
Name of Pet*
Choose One*
Gender*
Is your Pet Neutered/Spayed?*
What Services are Required *
Which Vet are you using?*
What amount are you able to pay for this service?*
I pledge to reimburse VIPP with a payment of this amount each month.*
Financial Reason For Request*

Meets HUD low income levelSenior Citizen/Fixed IncomeUnemployedDisabled
Monthly Income*
Estimated Cost of Veterinary Services*
Amount you are able to pay for the service?
Applicant's Signature*
Date*

MonthDay Year
Date
Vashon Island Pet Protectors (VIPP) requires this information to process your request of financial aid. ASSISTANCE WILL NOT BE GRANTED WITHOUT FULL COMPLETION OF THIS FORM. All information is confidential. Applicants must be at least 18 years of age or have a parent or guardian apply on their behalf. Assistance funding is limited and is provided at the sole discretion of VIPP. VIPP assumes no liability for veterinary services received under this program.
Someone from VIPP will get back to you in a timely manner.
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