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Frederal Express Memorial Fund Application
For One Set of Doggy Steps
Thank you so much for your interest in applying to our Frederal Express Memorial Fund. Please take a moment to answer a few questions so that we can get to know you and your pet a bit better! Once your application is processed, we will get in touch with you to let you know the status of your application. After we have pre-qualified your application, we will ask that you submit a photo to us of your pet (to be used on Fred's Page,) and that you also email or fax us a copy of either your SSI/AFDC/SSA Award letter, or a copy of your most recent check stub. (Please use a black marker to cross out any Social Security numbers or other sensitive information that may be on your form before sending it to us.) If you have any questions, please feel free to contact us!
Name
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Pet's Name
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Address
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Telephone Number
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Email Address
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Age of your Pet:
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Please describe your pet's condition
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What is your annual income?
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Source of Annual Income
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How many people are in your household?
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How many pets live in your household?
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Please list one reference below.
Name of Reference
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Telephone Number of Reference
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Email address of reference
Below, please list your veterinarian's information.
Name of Vet
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Telephone Number of Vet
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We welcome your comments! Please tell us any other factors that you would like us to consider in reviewing your applicaton.
By submitting this application you agree to the following: If you receive notification from us that your application has been pre-qualified, upon our request you will submit a photo to us of your pet (to be used on Fred's Page) and that you will also email or fax us a copy of your income verification within a timely manner. You also agree that you understand that we have a limited number of doggy steps available and that approval of this application is also based on product availability.
Please type your name here as your internet signature.
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Today's Date
mm/dd/yyyy
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