Vehicle Donation Program

Vehicle Donation Form

UNITED CEREBRAL PALSY
VEHICLE DONATION FORM
Phone: 1-800-4WHEELS
Fax: 410-484-1257
Please Print

Last Name on Title________________________________________

First Name_______________________________________________
Address_________________________________________________
City/County_____________________________________________
State___________________Zip Code_________________________

Daytime Phone:___________________________________________
Evening Phone:___________________________________________

Vehicle Year_____________
Make/Model______________________________________________
Color___________________________________________________

Vehicle Runs: Yes_____ No_____
Body Condition: Good_____ Fair_____ Poor_____

Mechanical Condition______________________________________

________________________________________________________

Learned of vehicle program: Newspaper/Radio/Word of Mouth (circle one)
Other Specify:___________________________________________

Location of Vehicle________________________________________
________________________________________________________
Phone #_________________________________________________
Contact person___________________________________________

Instructions: On back of title (Assignment of ownership block only) Purchaser or Buyers fill in United Cerebral Palsy Address: 1700 Reisterstown Road, Suite 226 Baltimore, Md 21208. Signature of Seller, please sign here exactly as shown on front of title. Then mail title to UCP along with this information sheet to:

That's it! Once the title has been received, the towing company will be notified by UCP to tow the vehicle, and you will receive a thank you letter within a week as well as a tax statement stating that the vehicle has been donated.

Questions?? Please contact Lisa Scott at 410-484-4540, ext. 4086 or 1-800-4WHEELS.

United Cerebral Palsy of Central Maryland, Inc., is designated as 501(c)(3) non-profit organizations. A copy of our audited financial statement is available upon request by calling or writing 1700 Reisterstown Road, Suite 226, Baltimore, MD 21208. Additional information is on file with the MD office of the Secretary of State.

United Cerebral Palsy of Central Maryland does not discriminate on the basis of race, color, national origin, sex, age, or disability.

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