SARAH: PBRC Spay Neuter Request - Dan Wright missouri

[sanya]

PBRC SPAY/NEUTER FUND APPLICATION

Date: Sun Apr  3 18:12:41 2011




OWNER OR CARETAKER INFORMATION:

Name: Dan Wright

Address: 9201 w. callahan creek rd

City: harrisburg

County of residence: boone

State : missouri

Zipcode: 65256

Phone: 5732682803

E-Mail Address: lynn.thef...@gmail.com

What is your dog's name?
ladybug

What is your dog's age?
1 to 3 years

What is your dog's weight?
60

What is your dog's gender?
female_spay

What is your dog's breed?
APBT

Do you own the dog?
i own the dog

How long have you had the dog?
1 year

Is this dog up for adoption?
avail_no

If so what is the rescue name?


Veterinarian's name:
farmer

Veterinary hospital or clinic name:
humane society o f central missouri

Veterinary hospital or clinic address:
616 big bear blvd

Veterinary hospital or clinic city:
columbia

Veterinary hospital or clinic state:
missouri

Veterinary hospital or clinic zipcode:
65202

Veterinary hospital or clinic phone number:
5734437387

Veterinary hospital or clinic fax number:
5734437387

Veterinary hospital or clinic contact name:
v et

Cost of surgery:
60.00

Amount willing to contribute:
20.00

Amount requested:
40.00

Does your household receive public assistance?
yes

If so what type of assistance?
food stamps

Are there circumstances that we need to be aware of
that would make the procedure more costly?
no

Have you contacted low cost spay/neuter resources for your area?
yes the humane society is $60

Do you have another application currently pending with
us for additional medical assistance?
No

Have you applied previously with PBRC for assistance?
No

How did you hear about the PBRC spayneuter assistance program?
a friend


--
You received this message because you are subscribed to the Google Groups "pbrc-spayneuter" group.
To post to this group, send email to pbrc-sp...@googlegroups.com.
To unsubscribe from this group, send email to pbrc-spayneut...@googlegroups.com.
For more options, visit this group at http://groups.google.com/group/pbrc-spayneuter?hl=en.

[sanya]

corrected fax number...

Veterinary hospital or clinic fax number:

5738756155