Sempervirens Fund: Vehicle Donation
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Please fill in form and click "Submit" below. For print/FAX, get as PDF.
Date: Donor Name:*
mailing address*

city, state, zip*

phone*

alternate phone
e-mail*
Vehicle location (if different than above):
street address
  city, state, zip
Vehicle Information
Yr*  Make* Model*
VIN #* License #*
   Please check all that apply:
       2-Door   4-Door   Station Wagon  4-Wheel Drive
    Does vehicle run 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:
* = required