Pet Food & Supply Bank Application

Pet Food & Supply Bank Application

Please complete this application if your organization is interested in receiving free or low-cost pet food and supplies. If you have any questions about your agency's eligibility to participate, please include them with your application.
Organization Name
Website
I affirm that I have the authority to act on behalf of this organization
Contact Person's Name

First NameLast Name
Contact Person's Job Title
Your job title, role, or relation to the organization
Contact Person's Email
example@example.com
Contact Person's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization's Employer Identification Number (EIN)
Organization Type
Is your organization a 501(c)3 non-profit ?
501(c)3 Letter

501(c)3 organizations, please click "Choose File" to upload your IRS letter of determination
Cancelof
Organization's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County in Georgia
If your organization is not based in Georgia, please indicate the state
What types of animals does your organization serve? For human service agencies, select the types of pets that your clients own. Select all that apply.
Does your organization have a veterinarian on staff? If yes, please provide their name and license number below.
Dr. Jane Doe, VET000001
Current Services
Please describe the services your organization provides to the public
Fees for Services
Please describe any mandatory fees, deposits, or costs associated with the services you provide.
Client Type
Please describe any demographic or client type service limits your organization has. "We provide services only to senior citizens age 65 and up" or "We serve primarily veterans", etc.
Geographical Service Area
Please describe any geographical limits to the services you provide. "We serve only residents of Fulton County" or "We serve anyone who can drive to our location", etc.
How do you plan to incorporate pet food and/or supplies from this program into your current service offerings?
Does your organization have safe, dry storage conditions for pet food?
What is your organization's maximum pet food storage capacity?
Will your organization provide an occasional picture and story of an individual or pet who received food or supplies from this program? By selecting yes, you confirm that your organization has the proper release of information documents in place to ensure all approvals are obtained.
Reference #1 Name

First NameLast Name
Reference #1 Email
example@example.com
Reference #1 Associated Organization
Reference #2 Name

First NameLast Name
Reference #2 Email
example@example.com
Reference #2 Associated Organization
I am aware that any pet food or other donations provided cannot be sold, used to solicit donations, or exchanged for other goods. These requirements also apply to individuals receiving donations from my organization. Evidence of these activities by the recipient organization or individuals receiving assistance from the recipient organization will result in immediate dismissal from the program
Any questions or details you'd like us to know more about?
Let us know here!
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