Magic Bullet Fund provides assistance for people who need financial assistance for their dogs cancer treatments. Those who are able to provide treatment for their dogs with cancer by any other means, without our assistance, should not apply.


TO APPLY:
  1. Alert your veterinarian that someone from the Magic Bullet Fund might call him/her. Give your permission for them to freely discuss with us all aspects of your dog's case.

  2. Provide financial info the SAME DAY that you submit this application. Email HERE or fax to (914) 206-4301.
    3. Send us the first page of your most recently filed tax return. Cross out your social security number.
    If you are married filing separately, send the first page of both returns (yours and your spouse’s).
    * If you do not file federal taxes: 

    Send your bank statement for the past 2 months. Go online to your bank account. Get a pdf of the monthly statement for last month. We need the actual statement, not a list of transactions - it should look like the statement you would get in the mail. Save as a pdf file and fax or email to us. Send the entire statement, all pages.
    Also send any documents that show your financial distress such as social services statements, disability statements, unemployment statements, bankruptcy letters, foreclosure notices, etc.
  1. Fill in and SUBMIT the form below. After we receive your financial info (#2 above), we will review your application, contact your veterinarian and then contact you. * We will not review your application until we receive your financial info (#2 above).
APPLICATION FOR ASSISTANCE
*  Tab key moves from field to field.
ABOUT YOU
Your Full Name    Your Date of Birth 
Name of Spouse or live-in boyfriend/girlfriend (or type NONE)  
Email Address       Re-type Email Address   
Phone Number #1 Phone Number #2   
Street Address      City State    Zip 
YesNo   Are you currently employed?  (If you collect unemployment, fax letter or stub to 914-206-4301)
Position/Title or job description AND date of employment at your most recent job    
Employer Phone
Occupation of Spouse live-in boyfriend/girlfriend (current or most recent job)    
Employer Phone 
Household income last tax year     Household income this year (estimate)  
Your current checking acct balance    Your current savings (inc. pensions)  
If you receive social services, which and how much?    
If you (or any adult in household) are disabled receiving disability insurance, explain the disability
 
Names/Ages of anyone you claim as a dependent      
Names/Ages of other pets in your home 
YesNo:  Do you own your home?    What are your monthly mortgage or rent payments?
ABOUT YOUR DOG
Name          Breed         Age           Weight    
Sex  M  F
Yes No:   Is your dog Spayed/Neutered?   * If not, why not?    
If you have pet insurance, provide name of company and policy number        
Type of Cancer (if tumor, what type and where?)      Date Diagnosed   
Treatment given up to now      
Treatment Recommended    
Most recent vaccinations (name of vaccine and date given)
* Please do not give vaccinations to a dog with cancer! If your dog is due for Rabies, open and print the Vaccination Waiver form here.
(You can click now, it won't make this form disappear).
What other major health issues has your dog had (include past cancers) ?
What other organizations have you applied to for help with your dog's cancer treatment fees?
Include name of organization, phone number, website address, name of person you spoke to, response to your request.
Did they provide any funding, how much?
Have you applied for assistance to pay for your dog's treatment from CareCredit?
 Yes No -  If yes, what was their response?  
ABOUT THE VETERINARIAN PROVIDING CANCER TREATMENT
Vet's Name   Clinic Name   Phone Email if known
  Yes No:  Have you given this vet permission to speak with Magic Bullet Fund about your dog?
* If we call your clinic and they haven't received your permission, your application will be discarded.
Yes No: Would you be willing to switch to a different doctor for your dog's cancer treatment? (Say no if you especially like the doctor you are seeing.) There may be a doctor in your area who we have worked with before.
ABOUT YOUR GENERAL PRACTICE VETERINARIAN
Veterinarian's Name     Clinic Name       Phone
A FEW FINAL QUESTIONS
Briefly, what is your financial situation? Why do you need assistance?  What will you do if MBF cannot help?
* Limit 100 words.
What amount are you able to pay toward your dog's cancer treatment?
If your dog needs surgery, type the amount you can pull together in the next 2 weeks.
If your dog needs chemo, type the amount you can contribute each week.

If your application is accepted, are you willing and able to put some work into raising donations into your dog's fundraising campaign?
Describe what makes your dog special. How will you feel if you find out that his treatment will be funded?
* Limit 100 words.

Do you understand and agree to the following conditions that apply if you receive MBF assistance? (READ ALL)
We cannot review application if you do not click Yes below.
 Yes No
  • MBF will start your dog's fundraising campaign with a gift from our General Fund. Then, you (and we) will work to raise donations. Donations for your dog will be held on reserve for your dog's cancer treatment costs. MBF Funds are never used to pay past due fees, routine health care, any medical treatment not for cancer, palliative care, euthanasia, burial or cremation.
  • For dogs in chemotherapy: If accepted, MBF will make a launching donation for your fundraising campaign. MBF will create and maintain a fundraising campaign for your dog on the Funds Needed page. Using MBF launching donation plus 90% of all donations made into your dog's campaign, MBF will contribute a set amount for each chemo treatment. The campaign will be active for 30 days. As you work donations to MBF for your dog, the amount MBF contributes per treatment increases. MBF pays the clinic directly.
  • For dogs having surgery: MBF will contribute a luanching donation to start off your fundraising campaign. The campaign will be active until 5pm the day before your dog's surgery. The launching donation plus 90% of all subsequent donations made into your dog's reserve as a result of your and MBF's fudnraising efforts will be contributed to your dog's surgery fees if needed.
  • You will write an email to your friends and family within a week of acceptance asking for donations to MBF for your dog (MBF will send you a sample email). You will run an active fundraising campaign to raise donations to MBF for your dog.
  • You will post an update on the MBF forum online twice a week while your dog is in Fundraising. (MBF will send you instructions for joining the forum).
  • MBF has your express permission to discriminately and discretely share the information you send us with other organizations, for the purpose of raising funds for your dog's treatment.
  • You will inform MBF of any media attention (newspapers, magazines, radio, etc) to your dog's cancer journey, and of any funding contributed for your dog's treatment other than MBF funding.
  • If MBF arranges a media story (TV, newspaper etc.) about your dog and the assistance you received from MBF, you will be available for interviews and photos with the producer, journalist or editor.
  • Funds raised for a dog do not belong to the recipient or their dog. When a dog no longer needs treatment, when treatment is not successful, when a recipient doesn't comply with MBF policies, or when MBF has raised more funding than needed, funds on reserve for that dog are redistributed to the General Fund and used to help other MBF dogs in need of funding.
  • Recipients of MBF assistance are encouraged to become volunteers for MBF but may not do so until 3 months after their dog has completed fundraising.
  • You may not make a donation to your own dog's fundraising campaign.
  • MBF has your permission to print or post all photos / text that you send us or that you post in the MBF forum, to promote MBF.
  • Magic Bullet Fund is not in any way responsible for the results of your dog’s treatment, the quality of your dog’s medical treatment or any treatment side effects.
Reminder: MBF will not review this application until we have also received page 1 of your most recently filed tax return.
Fax it to (914) 206-4301 or send by email to forms@themagicbulletfund.org.

   
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