Bright Futures Farm

Vehicle Donation Form

* When complete, please fax this form to Car Program at 916-631-1307 or to us at 814-827-8278.

* A towing service will call you within four business days to schedule an appointment.

Donor Information:

Date: _______________________

Name ______________________________________________________________________

Address (car’s location) _________________________________________________________

City _______________________________________ State _______ Zip _______________

Phone # ___________________________ Alternative # _____________________________

Vehicle Information:

Year _________ Make __________________ Model ______________________________

License # __________________ VIN # __________________________________________

Please check all that apply: _ 2-Door _ 4-Door _ Station-Wagon _ 4-Wheel-Drive

Does the vehicle run and drive as is? _ Yes _ No, explain___________________________

______________________________________________________________________________________________

Problems:

Engine __________________________________________________________________

Trans. __________________________________________________________________

Body __________________________________________________________________

Other __________________________________________________________________

None ___________________________________________________________________

Special Instructions: __________________________________________________________

____________________________________________________________________________

___________________________________________________________________________________________________