The Children's Home Vehicle Donation Program

Call NOW! 1-877-TLC-KIDS or email us at kids@chbc.org

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First Name

Last Name

Phone:

Alternate Phone:

Email:

Fax:

Vehicle Location Address:

Vehicle Location City:

Vehicle Location State:

Zip:

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle License #:

Vehicle VIN#

Please check all that apply:

2-Door 4-Door Station Wagon 4-Wheel Drive

Does vehicle run & drive?
In NO, please explain:

Do you have the Title?
If NO, please explain:

Please Note Vehicle Problems or Damages :

Description of Engine Damage/Problems:

Description of Transimission Damage/Problems:

Description of Tire Damage/Problems:

Description of Body Damage/Problems:

Description of Other Problems/Damage:

Special Instructions:

 

 

Return to Vehicle Donation Homepage

 

 

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