Special Services Application

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Personal Data

Visual Status


Are you a member of MCB? If not a member of MCB, applicant must submit verification of blindness (letter on official letterhead from doctor, state or private agency.)

Application Information

NOTE: If approved, all attempts will be made to make a check payable to the third party.


  1. A signed release of information form must accompany your application
  2. Utility Bill: If request is for utility payment
  3. Other Bills: If other than utility, include bill with account number or customer ID
  4. Purchase: For purchases, include name of business, business address, phone number and price quote on Company letterhead.

Submit this electronic Application and mail Supporting Documents to:

Missouri Council of the Blind

5453 Chippewa Street

St. Louis, MO 63109