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Support KBDI

First Name:*
Last Name:*
Address 1:*
Address 2:
City:*
State:*
Zip:*	-
Primary Phone:*	- -
Alternate Phone:	- -
E-Mail:*	(Your privacy is important; your email address will not be shared with any other organizations.)

*Fields marked with an asterisk are required.

Type of Vehicle:
Year:
Make:
Model:
VIN Number:
Color:
Mileage:	Actual? Yes No
Location of Vehicle if it is not at the donor's address above:

Title is issued by which state:
Is the title in the donor's name?	Yes No

Please use this box for any further description of the vehicle and its condition:

Please note the following:

The title and keys must be available when the tow company arrives to accept the vehicle.
KBDI pays for the towing, so please be ready for the tow company.
Please remove all personal items.

Thank you for your generous gift! We will contact you soon regarding your donation.

Colorado Public Television - KBDI Channel 12 | 2900 Welton Street, 1st Floor | Denver, Colorado 80205 | Contact Colorado Public Television