Auto Ministry

Automobile Information Form:

Please provide the following information and our car donation coordinator will contact you:

Title:	Mr. Mrs. Ms.
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Daytime Number:	(use this format: 703-555-1212)
Evening Number:	(use this format: 703-555-1212)
Cell Phone Number	(use this format: 703-555-1212)
E-Mail Address:

Automobile Information Survey
Vehicle Make/Model
Vehicle Year
Transmission Type
Number of Doors

Do you have the title?: (if no, please explain)

From what state is the vehicle's title?

Is there a lien on the vehicle?

Does the car leak or burn oil?

When was the last safety inspection?

When was the last emissions inspection?

Describe the condition of the tires.

Does everything work? (if not, please describe)

Does it have AC?

What is the mileage?

Would you take it on the highway?

Has the vehicle been in any accidents?

What is the overall condition of the vehicle's body?

What significant repairs and/or maintenance have been done?

Is there anything that you believe needs to be repaired
or that is due for regular maintenance?"

Why are you seeking to donate this vehicle?