*Name of person making application

*Name of Rescue Group affiliation if applicable:

*Telephone:

*E-mail:

*Please describe what the grant is for in no more than 50 words. Include animal name and circumstances of rescue if possible.

*Please state the nature of the grant
-- Select --Veterinary CareBoardingTrainingOther

If other, please explain:

How much are you requesting?

Name of “supplier” who will receive direct payment:

Telephone:

E-mail:

Contact person or additional information:

Please attach suppliers' or providers' cost estimates if available.

• I declare that the information given on this form is true and that any funds received would be solely for use as detailed above.
• I understand that Friends of Animal Rescue has the right to deny my fund application for any reason.
• I have fully completed this application form, and enclosed cost estimates.
• I understand that any enclosure will not be returned.
• I agree to make invoices/receipts available on request.
• I agree to abide by any conditions set out by Friends of Animal Rescue in making the grant.

*Print name:

*Date:

e-mail of this form constitutes an electronic signature to the above conditions.