Donate my vehicle to Horizon Goodwill Industries

DONOR INFORMATION
Donor's Name:
Day Phone:
Evening Phone:
Mailing Address:
City/State/Zip
VEHICLE INFORMATION
Vehicle Location:
Year/Make/Model
Vehicle Color
Mileage:
VIN Number
4 X 4  RWD  AWDRunning    Non-Running
Title:   Yes  NoMailing Title  Yes  No
Lien ReleaseYesNoSpouse on Title  Yes  No
Title State
Name on Title:
Keys  Yes  NoDrive 50 Miles  Yes  No
Tires Inflated  Yes  NoRollback Accessible  Yes  No
Need to be towed on flat bed     Yes     No
Does vehicle need jump start     Yes     No
BOATS
Trailer  Yes  NoTrailer Tires Inflated  Yes  No
Waterworthy  Yes  NoTrailer Can Tow Boat  Yes  No
Length  Height  
What size hitch 
CAMPERS
Driveable  Yes  NoCamper tires inflated  Yes  No
Pop Up  Yes  NoPull Behind  Yes  No
Length  Height  
What size hitch 
DRIVERS NOTES
  AM  PMLeave Receipt  Mail Receipt
Vehicle LocationResidence  Business
Location of Title/Keys:
Best Number to reach donor:
Additional Notes:
Image Validation:
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in the image to the right.
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Characters:


Phone: (301) 733-7330
©Copyright 2009

Horizon Goodwill Industries
14515 Pennsylvania Avenue, Hagerstown, MD 21742

Fax: (301) 739-7144
All Rights Reserved