County Animal Transportation Survey

1. Company/Organization Name __________________________________________

Address ______________________________________________________________

Phone (    ) _____-_________ Fax (     ) _____-_________

2. Representative’s Name _______________________________________________

Representative’s Phone ( ) _____-_________ Pager ( ) _____-_________

4. Would you be willing to provide transportation services during a disaster?

‘Pro Bono ‘Reduced rate _____________________ ‘Standard rate ____________

5. General information

Insurance Company ________________________ Policy # _____________________

Vehicle License Plate Number _______________ Description ___________________

Trailer License Plate Number ________________ Description ___________________

Trailer License Plate Number ______________________ Description ___________________

__________________
Draft On- line for
Nevada Animal Disaster Preparedness Guide

The draft was provided by the California Office of Emergency Services.
http://www.cdaf.ca.gov/programs/disasterprep.htm
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