VA Form 21-4502: Application for Automobile or Other Conveyance and Adaptive Equipment

VA Form 21-4502 PDF Details

There is no time limit for filing a claim; however, the claim must be authorized by VA before you purchase the automobile or conveyance.

By hand: if completed by hand, print the information requested in ink, neatly and legibly, insert one letter per box, and completely fill in each applicable check box.

Release: a service member planning early release should give both present military address and planned address following release from active duty, in Items 8A and 8B.

Equipment: adaptive equipment is not provided if the claimant is blind, requires a driver, or does not have a valid State driver's license or learner's permit.

Questions: contact VA online at https://ask.va.gov/ or call VA toll-free at 1-800-827-1000 (TTY: 711).