It must be more than six months since your previous request for a white cane.

I am blind or visually impaired, and this cane is for my personal use; OR

I am making this request on behalf of a child under the age of eighteen who is blind or visually impaired, and the cane is for his/her personal use. By selecting the checkbox below marked "I Accept", you acknowledge that you have reviewed and agree to all of the statements above.

* I Accept By requesting this white cane I acknowledge that:By selecting the checkbox below marked "I Accept", you acknowledge that you have reviewed and agree to all of the statements above.