MARE CAR DONATION FORM

Please be sure to have your title information available prior to filling out this form.
Route 128 Used Auto Parts & Sales' towing area encompasses the Eastern part of Massachusetts.

Location of the Car:

 (driveway, street, etc.)

Address:

 (Number, Street)
(City) (State) (Zip)
Do the tires have air in them? Yes No
You must have the title (or arrange for duplicate) in order for the vehicle to be picked up.

Title #:

VIN # (17 digits):

State:

Owner's Name:

Contact Name:

Home Phone #:

Work Phone #:

Email:

 (Required for receipt)
VEHICLE INFORMATION:
 Year: Make:
  Model: Color:
  Running? Yes No Mileage:
Please note any major mechanical problems:
Was the car in any accidents? Yes No
Body Damage:
Rust: Yes No

Mailing Address:

 (Number, Street)
(Apt., Suite, Floor)
(City) (State) (Zip)
How did you hear about the car donation program?
Additional Questions of Comments:

MARE is partially funded by the Massachusetts Department of Social Services.
Comments or Questions to: web@mareinc.org - Copyright © 2007 MARE, Inc. All rights reserved.