Inquiry/More Info Form to submit Online here.

Forms

Second Chance Veterans Charity is a 501(c)(3) non-profit organization dedicated to improving the quality of life of American Military Veterans who are disabled.


We provide free power wheelchairs and power scooters as a service to disabled veterans of America.

If you are in need of a wheelchair, please click on Application Form below, fill out the form and email or mail to us.  Both forms can be filled in and then printed.

Email to: Robert Hager   roberthager5742@gmail.com or
Email to:  Joe Plant:  plantjdv@live.com


Mail to:  Second Chance Veterans Charity
             5850 Canyon Way
​             Frederick, CO 80504 


Application Form (Micosoft Word Format)

Application Form (Adobe Format)