| RED CROSS MOTORS Vehicle Donation Program Application 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 OR FAX: 860-388-4477 |