River City Habitat for Humanity Vehicle Donation Form

DONOR

Name ____________________________________________________________________________________

Company _________________________________________________________________________________

Address __________________________________________________________________________________

City, State, Zip_____________________________________________________________________________

Phone__Day                                                    Evening                                                                Mobile or Cell                                                                                                          

By signing  this document I attest that I have read and/or been made aware of the Fair Market Value Page on this website.  Signature _________________________________________________________________________

Vehicle

Year__________________Make_____________Model_______________

Color____________________________Mileage_____________

Vin #________________________________________________

Referred to River City Habitat for Humanity (  please check one )

___ Radio___ Television___Newspaper

___ Word of Mouth___ Previous Donation

___ Other___________________________( please be specific)