CTC%20Vehicle%20Donation%20Form
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To Donate Your Car to the Connecticut Challenge, please complete this form and fax to 203-621-3279. Or call us at 203-353-7690. Date _______________________ Donor Name _________________________________________________________________ Vehicle Location ______________________________________________________________ City _______________________________________ State _______ Zip _______________ Phone # ___________________________ Alternative # _____________________________ Mailing Address (If different than above) ________________________________________________ City _______________________________________ State _______ Zip _______________ 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____________________________ Do you have the Title? Yes No, explain_______________________________________ Please note any problems/damage: Engine __________________________________________________________________ Trans. __________________________________________________________________ Tires __________________________________________________________________ Body __________________________________________________________________ Other __________________________________________________________________ Special Instructions: __________________________________ _____________________ Connecticut Challenge 860 Canal Street, 3 rd Floor, Stamford, CT 06902 Tel: 203- 353-7690 Fax: 203-621-3279
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http://www.ctchallenge.org/Media/CTC%20Vehicle%20Donation%20Form.pdf
Transcript of CTC%20Vehicle%20Donation%20Form
To Donate Your Car to the Connecticut Challenge, please complete this form and fax to 203-621-3279. Or call us at 203-353-7690. Date _______________________ Donor Name _________________________________________________________________ Vehicle Location ______________________________________________________________ City _______________________________________ State _______ Zip _______________ Phone # ___________________________ Alternative # _____________________________ Mailing Address (If different than above) ________________________________________________ City _______________________________________ State _______ Zip _______________ Vehic l e 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____________________________ Do you have the Title? Yes No, explain_______________________________________ Please note any problems/damage:
Engine __________________________________________________________________
Trans. __________________________________________________________________
Tires __________________________________________________________________
Body __________________________________________________________________
Other __________________________________________________________________
Spec ia l Instruc t ions : _______________________________________________________ Connecticut Challenge 860 Canal Street, 3rd Floor, Stamford, CT 06902 Tel: 203- 353-7690 Fax: 203-621-3279
