Are you a senior or known a senior in need? Fill out the form below.
We will do our best to fit your needs while donation supplies last. We cannot guarantee donations will be available for everyone.
Your Full Name
Your Email
Telephone
Address
City
State VA
Zip Code
What items are you in need of?
Cold Weather GearToiletriesBlankets/ThrowsHair CareThermal BlanketLaundry SuppliesTowels
Additional Comments (optional)
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Full Name* Full Name* E-mail E-mail
How do you prefer we contact you:
Email
Phone or Cellphone Phone Number* Message Message
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Someone will contact you shortly. If you need immediate attention, please call our main number: 757-461-9481
