Step
three:
There are 4 documents you need.
These documents must be faxed to IMOM
before
we can send you an
application form.
Documents sent to IMOM
must have all personal
account information blacked out. This includes
social security number, bank account and bank routing
numbers as well as any other personal account numbers.
If account
numbers are visible IMOM will immediately destroy all
of the documents you have sent. If this happens you will be
required to send all documents
again.
Our fax number is:
630-214-8952 |
Document #1 - Estimate of costs Get a
written
estimate from the veterinarian who will be treating your pet for it's current condition.
The estimate must be on your veterinarian's letterhead and include the following
information or IMOM cannot accept it:
-
Your name and the name of your pet
-
A breakdown of costs for treatment
and
after care.
-
If your pet is not spayed or neutered that cost
should also be included in the written estimate.
-
How soon treatment should be provided to save the animal's life.
-
Your pet's prognosis.
-
The veterinarian also needs to confirm in
writing that they will work within IMOM's payment policy. If your
veterinarian is not familiar with IMOM, we have 3
documents you may print and take to them.
Click here
to find and print the letters.
-
Your vet must indicate whether or not
Care Credit is accepted at their facility.
Document #2 - proof
of household income
IMOM will need proof of income for all household
members.
Before sending any personal documents to IMOM please be sure to black
out any account numbers and/or your social security number.
Acceptable proof of income would be one
of the following:
-
Always
required - A copy of your most recent tax return
if you are required by IRS to file.
-
A copy of your most recent paycheck stub.
-
SSI benefits
-
Unemployment benefits
-
W-2 or 1099 from employer
-
A copy of your most recent bank
statement. The statement can be from either a checking or
savings account.
Document #3 -
Letter of denial from Care Credit
Document #4
- a signed agreement from
your veterinarian to acknowledge their willingness to
work with IMOM payment policies.
Our fax number is:
630-214-8952
|
