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An AT Exchange account is required to post the repaired item. Does your organization have an AT Exchange account?
Date Device was Donated to Your Program
Is someone waiting for the repaired item?
Terms & Agreement
Type your name in the box below to accept the terms of the following statement: I certify that the device repaired with Keep the Wheels Rolling Repair Fund is not owned by an individual with a disability, and will be reassigned to a new owner for free. The organization requesting funding and all individuals affiliated with the organization do not have the right to sell purchased parts or the repaired scooter/wheelchair.
IRS Determination Letter
For first time applicants, please also upload or provide a copy of IRS determination letter of tax-exempt status.