CONTACT INFORMATION

* Indicates required field

*First Name ________________________________  *Last Name _______________________________

*Email ____________________________________

Address _________________________________________________________

City _____________________________________ State ____________ Zip Code _____________

*Incorporated as a non-profit entity? Yes ______________ No _______________

*Non-profit corporation number: _________________________________________________

*Has the IRS granted tax deduction status for your organization? Yes _________________ No _________________

*What is your Federal Corporation Tax ID number? ________________________________________

*Solicitor's Name _______________________________________________________________

*State your relationship to the organization you are soliciting for? __________________________________

*Is your organization registered with the Better Business Bureau? Yes __________ No ___________

*What services are rendered by your organization?___________________________________________________

*What contributions are you seeking from us?__________________________________________________________

*Have you or your organization ever purchased a vehicle from us? Yes ___________ No ___________

*If yes, under what name(s)?_____________________________________________________________

*In what year(s)? ___________________________________________________________

*Solicitor's Signature _________________________________________________________

Date ________________________________________________________________