Thank you for filling out the Veteran's application. Someone should make initial contact with you within 72 hours. In the event you do not hear back within two weeks, please contact Luker at email@example.com.
WARNING: If you do not provide us with your complete documentation as requested, we will not be able to accept your application!
By completing this application I agree to waive all liability pertaining to the mobility device that I have selected. I agree that in the event that I no longer have a need for the equipment provided to me, I will return it so that another veteran may benefit from it.
I WILL NOT SELL THE DEVICE UNDER ANY CIRCUMSTANCE.