Vehicle Donation Form

Email*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Vehicle Location:

Vehicle Type:

Vehicle Year:

Vehicle Make:

Odometer Reading*

Title Number*

Title Owners Legal Name(s)*

Vehicle Model:

Vehicle Color:

VIN (required in order for vehicle to be picked up):

Vehicle Condition:

Is vehicle free of liens:

Do you have vehicle title?

Have plates been removed?

Car may be resold. Is this OK?

How did you hear about RFG?

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