Food Bank Assistance Application
Food assistance application
Pet food assistance
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Number of CATS in home.
*
Number of cats fed outdoors?
*
Number of DOGS in home.
*
Please list Breeds and Ages of dogs. Please add if your dog has food related allergies.
*
I need assistance with…
*
Dog Food
Cat Food
How long will you require assistance? You must reapply every 2 weeks- unlimited.
*
One time
every 2 weeks
What brand/type of food does your dog eat now? ( We cannot guarantee brand. We will attempt to match criteria. We are not a store, we have limited stock of certain foods. If you need specific brands we cannot assist. All brands are high quality.)
*
What protein does your dog eat? Fish, chicken, beef, lamb?
*
All goods are not for resale. Selling products distributed to you will result in termination of assistance. Food distribution is held on Sundays and Monday. Are you able to pick up on these selected days of the week?
*
In order to qualify for assistance you must agree to NOT add pets into your home either by breeding or adoption! Any puppies or kittens born due to breeding whether accidental or purposefully during your time in the program will be surrendered to us. Do you agree?
*
Are all of your pets spayed/neutered?
*
We supply food for 2 dogs and 2 cats IN your home. (Feral colony feeders please message us) Do you understand?
*
Pick up days are Sundays from 10am-1pm or Monday 3:30pm-5pm. You must choose a SUNDAY or Monday pick up date. ( You must fill form out every 2 weeks to pick up food.)
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-
Month
-
Day
Year
Date
Due to demand , you may have a reduced food quantity on certain weeks. We , will not, encourage or support breeding in any capacity. If you are breeding, either accidental or purposefully, you are disqualified. Do you understand?
*
You are approved ! Please arrive on your selected date to pick up your pet food. Please note: We do not email a confirmation. We will cross reference applications and social media. It is your responsibility to pick the food up. We do NOT deliver. You must abide by the rules to receive assistance. ** pick up 2515 west Jefferson, Trenton Mi. 48183 ** Do you understand?
*
Submit
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