Pregnant Mare Rescue,Inc.

Car Donation Information Form

First Name:* 
Last Name:* 
Address: 
City: 
State: 
Zip:* 
Daytime Phone: 
Alternate Phone: 
Email: 
Vehicle Location if different address than above: 
Vehicle Year: 
Make: 
Model: 
VIN: 
Damage to Body (describe): 
Damage to Interior (describe): 
Does the vehicle run and drive?: 
Do you have the Certificate of Title?: 
Mileage, Special Instructions, or Other comments: 

Please type the number you see below in the text box next to it.

 


Pregnant Mare Rescue,Inc.
PO Box 962
Aptos, CA  95001
USA
Phone: 408.540.8568

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