Donate a Vehicle – Maryland School for the Blind

Please provide the following information:

Submitter's Name:

Email*

Re-enter Email*

Donor's name as it appears on title:

Donor Title

First Name*

Middle Initial

Last Name*

If more than one name on the title, please provide the other name.

Secondary Donor Title

First Name

Middle Initial

Last Name

Current Address:

Address

Street Address Address Line 2 City State ZIP Code

Phone numbers:

(Note: A valid phone number is required in order to submit this form.)

Home Phone

Work Phone

Cell Phone

If vehicle is located at a different address, please provide:

Location Name

Location Address

Street Address City State ZIP Code

Contact Person at Location:

Contact Phone:

Vehicle Information

Year:

Make:

Model:

VIN:*

# Doors:

Color:

Mileage:*

Does the vehicle run?

Yes
No

Condition of Interior:

Condition of Exterior:

Mechanical Condition (please elaborate):

Are the tires inflated?

Yes
No

Do you have the keys?

Yes
No

Does the vehicle have a battery?

Yes
No

Is vehicle accessible to tow truck and not parked in garage or grassy area?

Yes
No

Is there or has there ever been a lien on the vehicle?

Yes
No

On the front of the title, if there is a financial institution listed, you will be required to have a lien release.

When your vehicle is picked up by our towing company, where would you like us to leave the receipt? (example: mailbox, under door, mail to me).

Yes
No

How did you hear about The Maryland School for the Blind?

Comments

Name

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