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Celebrating 30 years of non-profit service to The Santa Clara County
DONATE YOUR VECHILE TO OUTREACH!
Donating your vehicle is easier than selling and you will receive a tax deduction for your charitable contribution. One call does it all! If you are interested in donating a vehicle to the OUTREACH Car Donation Program, please print, fill out, and mail or fax the form below to:
OUTREACH
ATTN: Vehicle Donation Department
926 Rock Ave Ste 10
San Jose, CA 95131

Fax # 408-382-0470

CAR DONATION PROGRAM
VEHICLE PICK-UP REQUEST
OUTREACH AND ESCORT, INC. 926 Rock Ave, STE 10
San Jose, CA 95131 (408) 436-2865 FAX (408) 382-0470
- DONOR INFORMATION -
DATE: _____/_____/_____

NAME: _______________________________________________________

HOME ADDRESS: _______________________________________________
CITY: ______________________ STATE: __________ ZIP: _____________
DAY PHONE: (_____)___________ ALTERNATE: (_____)_______________
- VEHICLE INFORMATION -
YEAR: ________ MAKE: _______________ MODEL: ___________________
TYPE / # Doors: ______________COLOR_________Mileage:____________
Automatic or Manual #Cylinders:__________
LICENSE PLATE #: _________________ STATE: ________________
VIN #: _________________________________________________
Is the car running and is it safe to drive at least 50 miles? YES / NO
Will it require a tow truck? YES / NO
Do you have the Title? YES / NO Is it registered to you?___________
When will the Registration expire? _____________________
Vehicle Pick-up / Cross Street: ______________________________
_______________________________________________________
- VEHICLE CONDITION -
MECHANICAL PROBLEMS: _________________________________________
______________________________________________________________
______________________________________________________________
Exterior Condition: Good / Fair / Poor _______________________________
Interior Condition: Good / Fair / Poor ________________________________
How did you hear about our program?:_______________________________
_______________________________________________________________
Please call (408) 436-2865 Ext 251 if you have any questions.
 

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