Please tell us how you heard about us:
Monthly household income
Please describe source of income (employment, social security, disability, etc.)
Proof of financial hardship is required, such as a recent bank statement, unemployment income, etc. Scan and email proof to firstname.lastname@example.org or fax to 714-274-1613.
How many pets do you own?
# of cats
# of dogs
Number of other pets and type
Be aware that we may not be able to provide a specific type of food, but if your pet requires a special diet, please indicate the type of food required.
By accepting financial or food assistance from AALOC you agree to allow us to use all or part of your story (without disclosing your name) and pictures of your pet in our newsletter, on our website, Facebook, etc.
I declare under penalty of perjury, that the information provided above is true and correct to the best of my knowledge and I give AALOC permission to verify any information provided by including my signature below.