To expedite the donation process please provide as much information as possible.

CONTACT DETAILS
Name:
Phone:
Email:

VEHICLE LOCATION
Address:
City:
State/Province:
Zip/Post Code:
Fax:

VEHICLE INFORMATION
Year:
Make:
Model:
License:
VIN:
Damage to body (Describe)
Interior Damage (Describe)
Does the vehicle run/drive?:	Yes No
Describe reason if it is not running:
Special Instructions or Other Comments:

United Children's Fund, Inc.
PO Box 20341
Boulder, CO 80308-3341
USA

If you are having trouble with this form you may donate by telephone.

Please call 1-800-511-4409