Donation Form

If there is no collection site convenient to you we accept donated goods at our Apopka Florida location. If you ship to us please complete this form before sending. IMPORTANT: Include your contact information (name, address, tel. no.) with your shipment.

If you are unable to send items to us complete this form and we will notify our co-operating organizations of your donation offer. You may be contacted to make arrangements with them.

Items accepted: crutches, canes, walkers, wheelchairs, leg braces, prosthetics. All donated items must be in good condition and include all parts (including tips, if applicable):

* indicates required field

Contact Information

Name: * A value is required.
Address 1:
Address 2:
City: * A value is required.
State: Select a state AL AR AZ CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NJ NM NV NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY * Please select an item.
Zip:
Telephone: Invalid format.
Email: * A value is required.Invalid format.

Donation Information

Items offered for donation:

Please select your delivery method: Will ship - To

Will deliver locally

Available for pickup only
Please make a selection.

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