Chapter Vehicle Sign-Up Form

* Chapter Name:

Federal ID Number (EIN):

* Chapter Website Address:

* Chapter Contact Name:

* Chapter Contact Email Address:

* Chapter Contact Phone Number:

Chapter Contact Fax Number:

Thank you for your interest in The Arc's Car Donation Program.

Ron Farrin

Director, Call Center Operations

PONE: 301-856-6340
FAX: 301-599-0005

Email: RFarin@melwood.org

* Indicates Response Required