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Cars for Compassion Donation Form
Please remember we will need your title and key(s) at the time of pick up.
If you have questions please contact Daniel at (612)-695-2730
1.
* Date
2.
* First Name
3.
* Last Name
4.
* Street address (including apt. #) city, state and zip
5.
* Please list phone number(s) that we are able to reach you at: (home, cell, work)
Please include as much information about vehicle as possible:
6.
* Year
7.
* Make
8.
* Model
9.
Color
10.
Miles (approx.)
11.
* License Plate Number
12.
Vehicle Identification Number
13.
Please list any known major problems with vehicle (motor, transmission, flat tires...)
14.
* Is title clear?
15.
If No, do you have a lien release card?
16.
Any other additional comments (including if your vehicle is at a different place than above, please list the address below)
17.
* How did you find us?
Previous Donor   Word of Mouth
Radio   Star Tribune
MN Christian Chronicle   Web
Business card   Other

Type in the text that you see above:

  

Gospel Light Baptist Church
1114 - 22nd Avenue NE
Minneapolis, MN 55418

Phone: 612-871-6330

glbcmn@hotmail.com

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