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Gas Card Form

ROAD TO RECOVERY GAS CARD PROGRAM

  • Starting in 2023 Visa gas cards will be issued for the Road to Recovery program. They can only be redeemed at gas stations (ex. Shell, BP). Purchase must be made inside of station NOT at pump. Cards will be mailed 2-3 wks AFTER the application deadline by a third party vendor. Cards are valid for 6 months once received.

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  • This information is used collectively to help identify the population in which we serve for reporting to other non profit agencies and government.
  • Gas cards participation is not based upon need. Enduring Hearts uses the collective information for reporting to government agencies, and other non profits the population demographics in which we serve. Your information is private.
  • In order for us to process your request, please be sure to choose your child's correct social worker from the dropdown menu
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  • Visa gas cards can only be redeemed at gas stations (ex. Shell, BP). Purchase must be made inside of station NOT at pump. Cards will be mailed 2-3 wks AFTER end of cycle by a third party vendor.

  • This field is for validation purposes and should be left unchanged.

Please fill out the form below to sign up!