Click on logo to return to home page

Meals On Wheels Of Shawnee and Jefferson Counties, Inc. 5724 SW Huntoon St. Topeka, KS 66604 (785)670-2434

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

Select Contribution amount:	$1,600 (one year for one client)
	$800 (six months for one client)
	$267 (two months for one client)
	$133 (one month for one client)
	Other(enter amount)___________

In memory of:__________________________________________________________________________ Family to be notified:_____________________________________________________________________                              ______________________________________________________________________                              ______________________________________________________________________ Relation:_______________________________________________________________________________ Given by:_______________________________________________________________________________                 ________________________________________________________________________________                 ________________________________________________________________________________ Phone:____________________ E-mail:____________________ Credit Card:     VISA     MASTERCARD Card number:_______________________________________________________Exp. Date:__________