AMERICAN RED CROSS

Frederick County Chapter

PO Box 186

2 E. Frederick Street

Walkersville, MD 21793

301-662-5131

301-845-2689 fax

Email to: evonstein@frederickredcross.org

 

 

 

Vehicle Donation In-Take 2003 Form

 

Date

Contact Person:

 

Elizabeth Von Stein

Titled Owner (S)

 

 

Address/Mailing (current)

 

 

 

Address Vehicle Location

(either Chapter House or address)

 

 

 

Phone

H:

W:

Year/Make/Model

 

Approximate Mileage

 

Color

 

Vin# From Title

 

Lien Holder On Title

Yes (w/release notice)  or No

Drivable/Run (able to drop off @ chapter house)

Yes or No

Tags Removed

Yes or No (will be)

Where Parked (Driveway, front etc.)