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Meals On Wheels Of Shawnee and Jefferson Counties, Inc.
1500 SW 10th Avenue
Topeka, KS 66604
(785)354-5420



To make a contribution please print form, fill out, and mail in.

Select Contribution amount: $1,440 (one year for one client)
$720 (six months for one client)
$240 (two months for one client)
$120 (one month for one client)
Other(enter amount)___________


In memory of:__________________________________________________________________________

Family to be notified:_____________________________________________________________________

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Relation:_______________________________________________________________________________

Given by:_______________________________________________________________________________

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Phone:____________________

E-mail:____________________

Credit Card:     VISA     MASTERCARD

Card number:_______________________________________________________Exp. Date:__________