|
Name: ___________________________________
Address: __________________________________
City: _________________ State: ___ Zip: _______
Day Phone: ( ) ______________________
Evening Phone: ( ) ______________________
Vehicle Identification Number (VIN):
_________________________________________
Vehicle Make:
_________________________________________
Model: _____________________ Year: ________
Mileage: _______________Color: _____________
Location of vehicle if different from above: _________________________________________
Is the title free and clear of lien? Yes No
Can vehicle be driven 20 miles? Yes No
If No, is vehicle accessible by flatbed tow truck (i.e. driveway)? Yes No
Note: The vehicle MUST have four tires, a complete engine, and a title to be accepted into our program. Please remove license plates and all personal items from vehicle before scheduled pick-up date.
Donor
Signature: ___________________________Date __/___/___
Mail to: Vehicle Donation Processing Center
RedCrossMotors, P.O. Box 595
Old Saybrook, CT 06475
| Your Vehicle can help keep Our Vehicles on the Road! |
|
|
|