Form Builder

Please tell us how you heard about us:

Name

Address

City

State

Zipcode

Home phone

Cell phone

Email address

Employer name

Spouse/partner name

Monthly household income

Please describe source of income (employment, social security, disability, etc.)

How will you provide proof of financial hardship?

Proof of financial hardship is required, such as a recent bank statement, unemployment income, EBT etc.
You may provide proof by uploading a document directly to this application (preferred) or by scanning and emailing to aaloc@aaloc.org or fax to 714-274-1613.

Upload File Below
Email
Fax

Upload Proof of Financial Hardship Document

Please upload a document showing proof of financial hardship here to process your application faster.

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.

Signature

Date