vehicle donation intake form
lake washington college foundation/
lake washington technical college

Date:

Donor information:

Donor Name:
 Phone Number (with area code):
Street Address:
 E-mail:
City:
State: Zip Code:

vehicle information:

Vehicle Type: Vehicle Year:
Vehicle Make:
(example: Ford, Honda, Saturn)		 Vehicle Condition:
Exterior: Interior:
Vehicle Model:
(example: Explorer, Accord, SC1)		 Odometer reading (within 10,000 miles):
Engine size:

Is the vehicle in running condition?

If not, why not?
Does the vehicle have four inflated tires?
Tire condition: 		Whose name is the title in?
Location of vehicle:
Can the owner deliver the vehicle?
General description (please list outstanding features, needed repairs, good qualities, history):

Please check which of these features is included in the vehicle:

Manual transmission
Automatic transmission
Air conditioning
Tape deck
CD Player
AM/FM receiver
Cruise control
ABS
Power steering
Other special features (please list):

Thank you for your offer of a vehicle donation. Your application will be processed and someone will be contacting you on whether or not the vehicle will be accepted.

If you have a digital photo you would like to send, please e-mail it with your name and car make/model to nolan.koreski@lwtc.edu.

If you have questions, call (425) 739-8219.