Bengal Rescue Network (501C3)

Bengal Rescue Network (501c3)

Transport Application

BRN’s mission is to ensure that no Bengal cat roams the streets, goes hungry, sleeps in the cold,

requires attention, lacks affection, or remains alone to face an uncertain future.

Date:

Name: ______

Address: ______

City: ______State: ______Zip: ______

Phone: Cell Phone:

Primary Email Address: ______

Secondary Email Address ______

The best way to contact you is? ______

Occupation: ______Your Age (or approx age range) ______

Drivers License #...... State ______

Insurance Company______Policy #______

Have you had, in the last three (3) years, any moving violations or actions which resulted in you being charged, which pertain to the operation of any type of motor vehicle? If Yes, please explain.

______

Have you ever been charged or convicted of felony or misdemeanor animal abuse? [ ] Yes [ ]No

If yes, please explain:

______

Have you ever owned a Bengal cat? [ ] Yes [ ] No

Explain their personality:

______

Do you have a carrier that would be size appropriate for a Bengal? [ ] Yes [ ] No

Have you thought about the cost transporting a Bengal for BRN?? [ ] Yes [ ] No

Are you financially able to transport for BRN. [ ] Yes [ ] No

Do you have the time and interest necessary for transporting [ ] Yes [ ] No

How far are you willing/able to drive to pick up a foster cat? ______miles.

I understand and agree that when you transport for Bengal Rescue Network, the Organization has sole jurisdiction over decisions regarding the cat. _____Initials

I have read and understand, and will comply to the best of my ability, the information/guidelines for BRN.

I certify that the above information is true and that false information may result in nullifying this application.

Applicant's Signature: ______Date: ______

BRN accepts your typed name as an e-signature and is legal and binding.

After filling out completely, print and send, or email to your Regional Coordinator and/or:

Sal Vitale, President
Bengal Rescue Network (501c3)