Donor Information Sheet - Mers Goodwill (Page 2 of 3) in pdf

Donor Information Sheet - Mers Goodwill Page 2

VEHICLE DONOR INFORMATION SHEET

Please complete this form and send it to us along with your signed title.

Name:______________________________________________________________________________

Address_____________________________________________________________________________

City/State/Zip Code:___________________________________________________________________

Home Phone:_______________ Work Phone: ______________ Cell Phone: ______________

E-mail ___________________________________________________

VEHICLE INFORMATION

YEAR________ MAKE _______________MODEL______________COLOR_________

Mileage___________ VIN# _____________________________ Title#________________

Is the vehicle driveable?: ___ Yes ___No

Please list any known problems:

(example - dead battery, bad transmission, bad starter)

_________________________________________________________________________________________

Pick up location if different from above:

__________________________________________________________________________________________

How did you hear about our program?

___ Billboard

___Word of Mouth

___ In Store

___ Online Search

___ Goodwill Website

___Website Advertisement

___ Previous Donor

___ T.V.

Radio – ESPN, Y-98, KMOX, KEZK, WIL, ARCH, Other Station__________

___E-blast

Other __________________

Did you hear about a promotion? _____________________

TAX PAYER ID number will be required if claiming a deduction over $500. If required we will contact you.

Thank you for donating your vehicle to MERS/Goodwill!

1727 Locust Street, St. Louis, MO 63103

Donor Information Sheet - Mers Goodwill Page 2