Santa Rosa Community Health Centers

Contact Information

Santa Rosa

California

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Santa Rosa Community Health Centers (SRCHC) is dedicated to providing excellent, patient-centered, primary health care and health education to underserved people in our community, regardless of their ability to pay. We’re dedicated to caring for the whole person with dignity and respect. SRCHC is committed to the education of health care professionals and to creating a continuous learning environment for all staff.

Donate a Car to Charity
Please fill out the form below to donate a car!

Name*
Prefix First Middle Last Suffix
Email*

Phone*
Work Phone
Cell Phone
Address*
Street Address City State ZIP Code

Business Name

Business Phone
Vehicle Year*
Vehicle Make*

Vehicle Model*

Vehicle Color*

Numer of Doors
Current Mileage*

Registration*

Yes

No
State Vehicle Registered
State

Registration Expiration Date*
MM slash DD slash YYYY

Why don't you have the Registratrion?
Do You Have the Certificate of Title (Pink Slip)?*

Yes

No
Is the Vehicle in Running Condition?*
Why don't you have the Pink Slip?
Why isn't the Vehicle in Running Condition?
Vehicle Identification Number*

License Plate Number

Describe Mechanical Issues, if any
Describe Condition of Body
Describe Condition of Paint
Describe Condition of Interior
To Which Charity Would You Like to Donate Your Vehicle?*
Is the Vehicle Located at the Address Above?*

Yes

No
How did you hear about our car donation program?

Notate the address where the vehicle is located
Street Address City State ZIP Code

Comments
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