Vehicle Donation Form

First Name
Middle Name
Last Name
Address 1
Address 2
City
State
Zip Code
Day Phone
Evening Phone
EMail Address
How Did You Hear About the Program?
Why Did You Choose FHC's Program?

Year - Make - Model
Color
Number of Doors
Mileage
Vehicle Identification Number
Title Number/State
Any Damage?
Does the vehicle start?	Yes No
Is is driveable?	Yes No
Is the vehicles approximate value $5000 or more?	Yes No
Comments