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ABC car donation

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					                                                 ABC of Westport
                                               Vehicle Donation Form

* Please complete and email this form to info@abetterchanceofwestport.org
* The donor will be contacted within four business days at the latest.

Date

Donor Name

Mailing Address

City                                         State                                Zip

Phone #                                      Alternate #

Vehicle Location (If different than above)

City                                         State                                Zip

Vehicle Information:

Year                                         Make                                 Model

VIN #                                                                             License #



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:

				
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