The Rotary Club 
of 
White Rock  - Millennium
A Member of Rotary International

         

Donate A Car to Rotary

 
     
Home   [Donation Form]    Faqs   Programs   Status   About Rotary   Partners   Contacts   
 
  


Donate a car registration

Please fill the form below, scroll down and click 'register'.  

Alternatively you may  download an Adobe form that you can print, fill out and Fax to us.  Click here to download the Adobe form.
Were you referred to the Rotary Donate A Car program?:   

If yes, by whom were you referred?


Contact Information:
First Name: Last Name:  
Phone: Email:          
Address: City:             
Province: Postal Code:


Vehicle Information:
Year:     Make:             
Model:  
Is there any Damage to the outside? (Describe):  
Is there any Damage to the inside? (Describe):  
Does the vehicle run?:  
Do you have the registration?:  
Other Comments (please note other club affiliation and contact phone numbers):  
Rotarian Name:  
Rotarian Email: