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Greater Good Pet Food Bank
Nevada Affiliate

This is an application for animal rescue groups to apply for donations from the Greater Good Pet Food Bank Program. Donors provide wholesome, nutritious food on an as-available basis only. Greater Good and recipient organizations are not able to request specific food types (e.g., grain-free) or brands. Food and supplies (the “Donated Goods”) are for the Recipient Group’s use only. They may not be: a) redistributed without the expressed written consent of Greater Good b) sold, rented, or exchanged for other goods or services, nor c) presented for refund. Each Recipient Organization must complete their own application. Applications work best when viewed and completed using Firefox or Chrome. Submitting this form does not guarantee approval to receive products. Incomplete applications will not be processed. This form is for the Greater Good Pet Food Bank Affiliate of Nevada – Las Vegas.

Organization(Required)

Website(Required)

Site link to adoptable animals (direct link required, Do not put the word "Petfinder" or petfinder.com)(Required)

Facebook

Twitter

Non-Profit Tax ID#(Required)

EIN #(Required)

Please download the 990 Form at this link if you do not have one: https://www.irs.gov/pub/irs-pdf/f990.pdf

File(Required)

Max. file size: 512 MB.

Proof of Non-Profit Status - Upload a copy of your IRS Determination Letter AND Return of Organization Exempt from Income Tax Form (990 Form)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name / Completed by(Required)

Applicant's Position in Organization(Required)

Phone(Required)

Mission Statement(Required)

Animals Reside in(Required)

Foster Homes

Facility

Both

# of dogs adopted past 12 months(Required)

# of cats adopted past 12 months(Required)

Amount of Cash Assets(Required)

Average monthly need for dog food (lbs)(Required)

Average monthly need for cat food (lbs)(Required)

Describe food storage capabilities - include maximum food storage capacity(Required)

Do you Spay/Neuter all animals prior to adoption?

Yes

No*

* If no, please explain why

Describe Adoption Programs(Required)

# of employees(Required)

# of active volunteers(Required)

Facility Location (if applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does your organization have a contract to provide Animal Control Services for any city, county, or municipality? If yes, please explain.(Required)

Veterinary Reference-Please Provide Contact Information(Required)

Do you receive government grants?(Required)

Yes

Have you participated in a "donated" or "low cost" pet food program within the past twelve (12) months?(Required)

Yes

If Yes, please provide program name and frequency.(Required)

Please list other food sources(Required)

Why is your organization requesting support from Rescue Bank(Required)

(Required) Please list your Board Members' Names and Email addresses or phone numbers(Required)

Name

First Last

Authorized Representatives - All organizations must complete and list at least two (2) individuals.

Phone

Name(Required)

First Last

Email(Required)

Phone(Required)

By submitting this application you agree and acknowledge the following terms and conditions: 1. You are authorized to sign this agreement on behalf of this organization and certify that the information set forth in this application and supporting documentation is correct. 2. You have read and understood the criteria that apply to this application and certify that the group meets each one. 3. The IRS determination letter has not been revoked, canceled or modified. 4. That food shall be protected against dampness, deterioration, and mold or from contamination by insects, birds, rodents or other animals 5. That food spoiled or otherwise contaminated shall not be served. 6. To abide by restrictions or conditions of distribution, if any, imposed by the source of Donation and communicated to Recipient by Donor. 7. Any raw meat provided is not fit for human consumption and shall be used solely for feeding animals. 8. That feeding pet food to ruminant animals is prohibited. 9. To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels. 10. To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation. 11. That Greater Good may list your organization as a participant in its publications, website or other informational materials but will not sell or disclose non-contact information for any commercial purpose. 12. That goods or services are provided on an "as is" and "as available" basis. Greater Good expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose. 13. Your organization grants to Greater Good the following: 1) the right to include on its website a link to your organization’s website(s), 2) the right to use any image(s) that you submit to Greater Good or that may be recorded by Greater Good during or in connection with events that involve both organizations. 14. Permit monitoring, including a site visit if requested, by a Donor representative, as reasonable and necessary to verify that compliance with criteria, receipt, handling and use of Donation conform to this Agreement. 15. Applicant grants permission to Greater Good and its pet products donors to use information contained in this application for their internal evaluation and response procedures. 16. All Handling Fee payments are to be made payable to the Affiliate Organization or Greater Good, as requested, and in no event made to any individual or other organization.

I have read and agree to the terms and conditions described in this application.(Required)

Yes

Name

First Last

Personal Email(Required)

Enter Email Confirm Email

Personal Phone(Required)

Personal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about our program? (If you were referred, please list the name of the individual and/or organization)(Required)

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Greater Good Pet Food Bank Nevada Affiliate

Greater Good Pet Food Bank
Nevada Affiliate