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Car Donation South Carolina - SC
How did you hear about the NKF Kidney Cars?
(Where asked, please specify the information requested in the blank below, if you remember. Otherwise leave blank.)
Newspaper (which paper)
Radio (which station)
Billboard
Kidney-SC.org Web site
Other Web site (which site)
Word-of-mouth
Direct mailing
Television
Pamphlet (where obtained)
Brochure (where obtained)
Other
Specification from above question, if necessary:
Do you have title to vehicle?
Yes
No
Free of Liens?
Yes
No
Is the title a S.C. title?
Yes
No
Was the title issued after June, 1989?
Yes
No
VEHICLE MAKE:
MODEL:
YEAR:
COLOR:
Value:
Over $500
Less than $500
Salvage/Parts Only?
Yes
No
Or, can it go through auto auction?
Yes
No
General Condition:
Are all the tires on it?
Yes
No
Do they need air?
Yes
No
Will the car start and is it driveable?
Yes
No
[Columbia Area Only] If driveable, can you drive it in?
Yes
No
OWNER INFORMATION
Name on Title:
Your Name:
Email address:
Address:
City:
State:
Zip:
County:
Home phone:
Work phone:
Address where car is located:
Contact Name:
Contact Phone:
**** Remove plates, registration, insurance and valuables from vehicle. ****
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