BUN BILL™ CLAIM FORM

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

With Rabbit Savior’s BUN BILL™ ASSISTANCE program, you can submit up to three (3) claims per year in each of the following four main categories:

Wellness Services
Emergency & Diagnostic Services
Minor & Major Medical Services
Spays and Neuters

For information regarding specific exams, procedures, or treatments that are covered in each category, or if you're unsure about your remaining available claims, please contact us at info@rabbitsavior.com.

Who Is This Claim For?*

Summary of Health/Medical Issue:*

Vet Clinic*

Name of Clinic or Service Provider

Veterinarian's Name

Name of Veterinarian

Vet Clinic Phone Number

Area CodePhone Number

Vet Clinic Phone Number

Please enter a valid phone number.

Invoice(s) Total:

Upload Vet bills and all relevant documents here:*

Certification of Validity*

Rabbit Savior has my permission to contact my veterinary clinic or service provider to validate any examinations, procedures, or treatments for my rabbit(s).I understand that the Bun Bill™ Assistance program will only accept veterinary bills that can be confirmed by the service provider. Rabbit Savior will only process claims submitted with verifiable bills as proof of your expenses. If a bill or expense cannot be properly authenticated or its authenticity is in question, Rabbit Savior reserves the right to reject or decline payment.I certify that all the details, invoices, and service providers associated with this claim are accurate, and all the statements provided are factual.

What happens after I submit my application:

Rabbit Savior may take up to 30 days to review your application. Please do not submit more than one claim for processing at a time. Once your application is processed, we'll notify you via email. If you do not receive a response after 30 days, please contact info@rabbitsavior.com. Please complete the entire application as thoroughly as possible. The application won't be considered complete unless all required questions are answered. This includes the submission of any required photos and/or documents.

Rabbit's Name*

Rabbit's Age

Years or months

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Website*

Are you open to us calling your vet clinic or service provider to verify the treatment?*

YesNo

PASSPORT PAYMENT ID FOR CLAIM PAYOUT

EXAMPLE MUFASAROLEX@PPI

Certification of Validity

Phone Number*

Country CodeArea CodePhone Number