Submit information about yourself or someone else in need who could use the help of Cars 4 Christmas or Car 4 Heroes. * indicates a required field. 

ONLINE SUBMISSION OF APPLICATION PREFERRED 

 You can also fax the completed form to us here:

FAX: 913-643-3139 

We do not update status' once you submit your application, please remember we receive 15000 applications each year and are giving away 300 cars each year, your application will be kept on file for 1 year.

 If your are selected you will be notified by our selection committee for a personal interview. For Cars 4 Heroes you must prove you have been honorbly discharged or if active duty you must be in good standing before receiving a vehicle. If you have been deceptive you will not receive a vehicle.

                                   PLEASE DO NOT SUBMIT MORE THEN 1 APPLICATION

THANK YOU

Your Information

Please enter your information...

First and Last Name: *

Street Address: *

P.O. boxes are not accepted.

City: *

State: *

ZIP: *

Email: *

Phone: *

XXX-XXX-XXXX

Recipient Information

Please enter information for the possible donation recipient.

First and Last Name: *

Street Address: *

P.O. boxes are not accepted.

City: *

State: *

ZIP: *

Email:

Phone: *

XXX-XXX-XXXX

Military Service: *

Yes

No

Has the recipient ever served or family member ever served in the military ? Branch? What Years served?

Story

Submit a story: Why do they need a vehicle and how could it change their life?

Story: *

Additional

Help Cars4Christmas by letting us know how you heard about us and allowing us to keep in touch!

How did you hear about Cars4Christmas?:

Radio or TV

Publication

Other

Name of Radio/TV station, publication or other:

Would you like to be updated periodically by Cars4Christmas?:

Yes

No

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