Augusta Blind Rehabilitation

Center Alumni Association (ABRCAA)

Vehicle Donation Form

 Donor Information

Date   

Donor Name _

 Vehicle Location

 City   State  Zip 

 Phone #   (example:  803-777-1221)

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:  

_______________________________________________________________________________________________