Delivery Driver Application Form

If you want to volunteer as a delivery driver with Project Linus NJ, Inc.,
please mail the completed form below to: Project Linus NJ HQ, 79 Jackson St., Keyport, NJ 07735

Your Name (required)
  County   ---AtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarren

Address:

City   State   ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming   Zip  

Phone Number

Your Email

Availability of Day/Time (i.e. Wed. afternoon)

Coverage Area (county)

Driver’s License Number

Insurance Company Name

Policy #

Is there anything you’d like us to know?

The volunteer acknowledges, in using their own vehicle, their insurance carrier is solely responsible for their insurance coverage and for any and all claims arising from any activity performed for PLNJ.