APPLY FOR HELP - page 1

HOPE BEFORE HEAVEN INC.
P.O. BOX 2002
NEW MARKET STATION
NIAGARA FALLS. NY 14301

PHONE: 716-236-7346            FAX:  716-236-7137

EMAIL: hopebeforeheaven@ymail.com           WEB:hopebeforeheaven.com

REQUEST FOR HELP

To receive help from HOPE BEFORE HEAVEN INC. you will have to exhaust all
other means.

Apply for credit from Care Credit for Pets  (1-800-677-0718)
A. If accepted amount $________________

B. If denied we need the denial code__________________

Ask family or friends.

Use your credit cards.

Does clinic belong to Pet Emergency Fund of WNY?
A. If yes will they help and what amount? $_____________

B. If no why? ____________________________________

Do you have pet insurance? A. Yes_____   If yes you will have to fill out the
Release and Authorization of Payment form.

B. No _____

6.  Have you asked clinic if they will take payments?

A. Yes _____ If yes how much down payment is needed ? $______  

B.  No ______ If no Please ask.

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