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Donate a Car to Junior Center of Art and Science

First Name: *
Last Name: *
Email: *
Address: *
City: *
State: *
Zip: *
Day Phone: *
Evening Phone:
Vehicle Year/Make/Model: *
Vehicle Color: *
Current Mileage: *
Registration: * Yes No
Registration Expiration Date: *
Do You Have the Certificate of Title (Pink Slip)?: Yes No
Is the Vehicle in Running Condition?: * Yes No
Vehicle Identification Number: *
License Plate Number:
Describe Mechanical Issues, if any:
Describe Condition of Body/Paint:
Describe Condition of Interior:
Is the Vehicle Located at the Address Above?: Yes No
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