Magic Bullet Fund raises funds for dogs who, due to the caretaker’s financial constraints, would not be able to have or complete cancer treatment without assistance. Funding is not immediately available - after a dog is accepted into MBF, time is needed for MBF to raise the funds for treatment.

If you are able to provide treatment by any means, do not apply. 

TO APPLY:
1.    Alert your veterinarian that someone from the Magic Bullet Fund might call him/her. Give your permission to freely discuss with us all aspects of your dog's case. Please note that veterinarians treating MBF dogs are asked to provide a discount. We will establish this with your doctor after we review your application. If your doctor will not discount fees, but you wish to receive financial assistnace from MBF, we may be able to refer you to a doctor near you who will.

2.    Provide financial info BEFORE you submit the application
* We will not download any application unless we have already received your financial information.

Before you complete and submit the form below, email us the first page of your most recently filed tax return. Make a copy of the page, cross out your social security number and scan it into your computer. Store that file on your hard drive and then attach it to an email HERE. or fax to (914) 206-4301.

  • If you are married but filing separately, send the first page of both returns (yours and your spouse’s).
  • You may also attach other records to us to help us prove that you are in need of assistance. Send only 1 or 2 documents other than your tax return. Examples: foreclosure notice, unemployment check stubs/statements, bankruptcy documents, etc. MBF helps those most in need of assistance.
3.  Fill in and SUBMIT the form below. After we receive your financial info (#2 above), we will review your information, contact your veterinarian and then contact you by phone or email. If we cannot riase funds for your dog's treatment, you will receive an email saying this. If we can, you will receive an email with Subject Line "Magic Bullet Fund - Offer." Until you receive the "Offer" email, we have not agreed to raise funding.

* Do not submit application unless you have emailed or faxed your tax return. See #2 above.

MAGIC BULLET FUND APPLICATION FOR ASSISTANCE
*  Tab key moves from field to field.
ABOUT YOU
Your Name

Email Address
Re-type Email Address
Phone Number
Cell Phone
Street Address   City State    Zip 
Are you currently employed?  Yes No     * If no, fax unemployment letter to 914-206-4301 with tax return
Your most recent job
(job title)
Employer
Spouse's Name
Spouse Occupation
(current or most recent job)
Spouse's Employer
Total household income
Do you receive social services? (and why or why not)   
Names/Ages of anyone you claim as a dependent  
 
ABOUT YOUR DOG
Dog's Name            Breed              Age             Weight
Sex:MF                 Spay/Neutered? Yes No
   * If no, we will ask you to you approve this procedure if surgery is scheduled.
If you have pet insurance, type name of company and policy number        
Date Diagnosed   Type of Cancer (if tumor also say location)    
Treatment given up to now       
Treatment Recommended    
If your veterinarian gave an estimate of treatment cost, what is the estimate?
                                                        

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, it won't make this form disappear).

If your dog has any other health issues, what are they?

List below any other organizations to which you have applied for help.
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, fax your most recent CareCredit statement to (914) 206-4301 along with your tax return.
         If CareCredit declined to help, send us the denial (by email or fax).
         If CareCredit approved but you have no statements yet, send the approval letter to us (by email or fax).


Names/Ages of other pets in your home 
 
ABOUT THE VETERINARIAN PROVIDING CANCER TREATMENT
Vet's Name
Clinic Name
Phone
Clinic Street Address City State Zip
Have you given your vet permission to speak with Magic Bullet Fund about your dog?  Yes No
* If we call your clinic and they haven't received your permission, your application  will be denied.

Briefly, what is your financial situation? Why do you need assistance?  What will you do if MBF cannot help?
* Limit your response to 100 words.

What amount are you able to pay toward your dog's cancer treatment?
If your dog needs surgery, type in the amount you can pull together in the next 2 weeks.
If your dog needs chemo, type the amount you can contribute each week.
*MBF recipients are required to contribute as much as they can toward treatment. Start now putting aside any funds you can to apply toward treatment.

Describe your dog's unique personality and the important role he plays as a member of your family.
* Limit your response to 100 words.


Your Date of Birth 

Do you agree to the following conditions that will apply if your dog receives MBF assistance?
**(Response required)**
  Yes No
  • If you become a recipient of MBF assistance, you will write an update in the MBF Forum online at least twice a week and send an email to friends and family asking for donations to MBF for your dog. (MBF will send instructions for joining the forum and a sample email.)
  • MBF will send your veterinarian a Planned Contributions letter and a copy to you. MBF contributes to treatment costs only as specified in that letter, to the veterinarian named in that letter. MBF Funds are never used to pay past due fees, routine health care or any medical treatment not for cancer or palliative care, euthanasia, burial or cremation. Fees that MBF did not agree to pay are your responsibility. 
  • MBF pays the agreed upon amounts to the clinic, permitted that the funds have been raised. If fundraising efforts do not generate the goal amount, the MBF General Fund may contribute. When this is not possible, you will either postpone treatment or cover the balance.
  • 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.
  • 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 then to other MBF dogs in need of funding.
  • Recipients of MBF assistance may not make donations to MBF for a period of 3 months after their dog has completed fundraising.
  • MBF has your express permission to discriminately and discretely share the information you send us with other carefully selected organizations, specifically and only for the purpose of raising funds for your dog's treatment. 
  • MBF has your express permission to print or post photos and 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.
NOTE - MBF does not review an application until we have received page 1 of applicant's most recently filed tax return. Send this by fax to (914) 206-4301 or by email to forms@themagicbulletfund.org.

   
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