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Vehicle Pick-Up Request

Please fill out the Donor Information and Vehicle Information below. A towing service will call the donor within four business days to schedule an appointment for pick-up.

*Note: The fields marked with an asterisk are required.

NAME

Last * First *

ADDRESS

Street * City * State * Zip *

CONTACT

Home Phone * Cell Phone Work Phone Email * Fax Please update my records; I have moved

VEHICLE INFORMATION

Year

Make

Model

License Plate #

Does this vehicle run and drive as is? Yes No

If not, please explain:

Do you have the title?

Describe any damage to body or interior

THANK YOU

Thank you for completing this online form.
Please type in the security code into the box below it, be careful to type upper case letters as capitals.
To send this information to us click on the "Submit Registration" button below.

Security Code

Thanks for submitting your Registration Form!

You have successfully submitted your Online Registration Form. It will be soon received by our staff and processed. We appreciate your desire to be a part of our learning community as you develop your spiritual gifts and understanding of God's Word.

Please pay careful attention to the Calendar so that you show up for the classes on the right date and time. It is recommended that you begin to do some reading ahead of time to orient yourself to the class subject. Please pray for the instructor and other students so that God will richly bless and use the classes for His glory.

If needed you may now use the Financial Aid Form

In the service of Christ's Kingdom,
Cheryl Schlegel, Registrar