Please provide the following contact information:
E-mail:
@
First Name:
Last Name:
Street Address:
City:
State:
Select
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
Zip:
Home Phone:
Work Phone:
Please provide the following vehicle information:
Year:
Make:
Model:
VIN:
Mileage:
Color:
Running?
Yes
No
Tires Inflated?
Yes
No
Title?
Yes
No
Is Title in the name of donor?
Yes
No
Interior Condition
(Describe)
:
Exterior Condition
(Describe)
:
Mechanical Condition
(engine, transmission, tires, etc.)
:
Special Instructions, comments:
How did you find us?
Please Choose:
Internet
Newspaper
Radio
Other
If on the Internet, through whom?
Please Choose:
Google
MSN
AOL
Yahoo
Ask Jeeves
Landings.com
JPost
expressindia
Harvard Crimson
Daily Star Online
Other
Thanks for helping our Special Kids!
CHARITY@CHECKOUT creates goodwill that is
good business, and doing good.
Offer your customers a compelling cause to make a small donation to - let them leave your site feeling special about themselves and feeling special about you.
Car donations
are one of the easiest ways of helping special needs children and at the same time receive a tax deduction. Many of our kids are from communities that cannot afford the kind of one-on-one specialized care and expensive equipment necessary for them to thrive.
Copyright © 2004 Special Kids Fund