<p> The Arc of Southern Maryland Car Donation Form</p><p>* Submitter's Name:</p><p>* Submitter's Email Address:</p><p>* I would like the proceeds of the sale of my vehicle to benefit: The Arc of Southern Maryland</p><p>Name as it appears on title:</p><p>Last Name: </p><p>First Name: </p><p>Last Name: </p><p>First Name: </p><p>Company Name: </p><p>Current Address: </p><p>Cross Street: </p><p>City: </p><p>State: </p><p>Zip: </p><p>Home Phone: </p><p>Work Phone: </p><p>Cell Phone: </p><p>Is the vehicle located at the above address? If not, indicate car or vehicle location for free towing or pickup. Location Name (i.e. private residence, Smith's Repair Shop, etc.)</p><p>Current Address: </p><p>City: </p><p>State: </p><p>Zip: </p><p>Contact Person: </p><p>Contact Phone: Vehicle Information</p><p>Year: </p><p>Make: </p><p>VIN: </p><p>Model: </p><p># Doors: </p><p>Mileage: </p><p>Color: Does your car or vehicle run:</p><p>Yes</p><p>No To maximize the value from the sale of your vehicle, could you describe:</p><p>Condition of Interior: </p><p>Condition of Exterior: </p><p>Mechanical Condition (please elaborate): Help prepare us to tow your car or vehicle: </p><p>Do you have keys? </p><p>How do you rate the tires? </p><p>Are the tires inflated? </p><p>Does the vehicle have a battery? </p><p>Is vehicle accessible to tow truck and not parked in garage or grassy area? </p><p>Title Number: </p><p>Title State: </p><p>Title Control Number: </p><p>Is there or has there ever been a lien on the vehicle? On the front of the title, if there is a financial institution mentioned, you will be required to have a lien release.</p><p>When your vehicle is picked up by our towing company, where would you like us to leave the receipt? </p><p>(Example: mailbox, under door, mail to me) </p><p>Have you heard of The Arc? </p><p>How were you referred to The Arc? </p><p>We welcome your comments in the space below. * Indicates Response Required </p>