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

Phone

This field is for validation purposes and should be left unchanged.