BABS

Birth and Baby Services

602-321-0074

Income Affidavit

I receive one or more of the following
If you check one of these boxes, there will be no cost for our services, however we will require documentation
Family of 2 monthly net income (after taxes)
Your "family" number includes this pregnancy
Family of 3 monthly net income (after taxes)
Your "family" number includes this pregnancy
Family of 4 monthly net income (after taxes)
Your "family" number includes this pregnancy
Family of 5 monthly net income (after taxes)
Your "family" number includes this pregnancy
Family of 6 monthly net income (after taxes)
Your "family" number includes this pregnancy
We are a family of 7 or more including this pregnancy
Our service fee (if any) will be based upon a sliding scale
Honesty Agreement*
If it comes to our attention that you have not been honest with us in regards to your monthly income (birthing client, spouse/partner or parent(s) if birthing client is a minor) BABS birth and baby services has the legal right to adjust the total amount due for our services for up to 12-months from the date the birthing client gave birth and any and all legal fees incurred by BABS - birth and baby services the birthing client, spouse/partner or parent(s) if birthing client is a minor will be responsible for.
Income confirmation *
Agree to these terms*
Any & ALL fees listed above and here within non-refundable and payable at the times stated here within should you change your mind about using our service, not make it to your chosen birth location in time to deliver, or any other circumstances that should arise after signing this work agreement. You will be billed for all applicable service fees not paid should this herein occur.
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Thank you! Your message was sent successfully. We will add this information to your file. Please have all income verification paperwork ready to provide to us at our first meeting.