Vehicle Donation Form | Ways to Help | Teen Challenge Canada

Vehicle Donation Form

Vehicle Information

Vehicle Type:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Colour:
VIN Number:
Truck Cab Type:
Truck Box Type:

Drivetrain:
Tranmission:
# of Doors:
Exact Odometer Reading:
When was it last driven?
Is the vehicle driveable?	Yes No
Will the vehicle start?	Yes No

Vehicle Condition

Engine Condition:	Poor Fair Good Excellent
Engine Comments:
Brakes Condition:	Poor Fair Good Excellent
Brakes Comments:
Tires Condition:	Poor Fair Good Excellent	Tires Inflated?	Yes No
Tires Comments:		Tires Hold Air?	Yes No
Steering Condition:	Poor Fair Good Excellent
Steering Comments:
Transmission Cond.:	Poor Fair Good Excellent
Transmission Comm.:

Vehicle Condition (continued)

Other Comments on Vehicle Condition:
Rust on Vehicle:	None Minor Intermediate Major
Where is the rust?
Body Damage:	None Minor Intermediate Major
Where is the damage?

Are you the registered owner of the vehicle? Yes No

YOUR CONTACT INFORMATION
(exactly as per vehicle ownership)
First Name:
Last Name:
Organization Name:(business donors only)
Email Address:
Phone:
Address:
City, Prov:
Postal Code:

VEHICLE OWNER INFORMATION
(exactly as per vehicle ownership)
First Name:
Last Name:
Org. Name:(business donors only)
Address:
City, Prov:
Postal Code:

Delivery Information

How would you like the vehicle delivered to Teen Challenge? I will deliver it to Teen Challenge. Please pick it up at my address. Please pick it up at the owner's address. Please pick it up at another address.

Address:
City, Prov:
Postal Code:

Contact Name:
Contact Phone:

How did you hear about Teen Challenge Vehicle Donations:

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