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What is the Teddy Bear Cops Charity Program?
Donation Form
Tax Information
1-877-327-1229
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Name (First and Last):
Street Address:
City:
State:
Zip:
Cell phone:
Daytime Phone:
Email address:
(This is required)
Boat Make:
Model Description:
Boat Year:
Hours in service:
Length and Width of boat:
The name of the boat:
HIN (Hull Identification Number):
Do you have the Certificate of Title? Please write how the name(s) appear on the TITLE:
State Registration Number:
Condition of hull including any damage:
Condition of interior including any damage:
HP of Engine(s):
Type of engine: (If NONE, please select that).
Condition of engine(s)? Please fully describe the engine including whether working and any other details:
Is the boat seaworthy? (Provide details if needed)
Condition of trailer: Please describe the trailer and its current condition:
Will the trailer safely transport the boat?
Registered? Current?
VIN (Vehicle Identification Number):
License plate number:
Location of boat (address, city, state & zip):
Phone number & name of any contact person. NOTE: If boat at marina, name & number of contact person at marina:
Special Instructions or comments:
***Tax Receipt or Coupons/Vacations/Cruise:
Thank you for your participation in our program.
We will process your form and then you will be contacted very soon by email.
Please stay alert for email responses. If for some reason we are not able to pick up in your state we will let you know.