Program Registration Form

Follow these simple steps:

Contact our program coordinators, Mike Riccomi at 408-268-3814 or Michelle Warden at 408-982-9200 if you have any questions.

Organization:______________________________________

Contact Name:_____________________________________

Brief explanation of fundraiser:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Check made payable to:_________________________________________

_________________________________________

Send anyone you know who is in need of collision repair to any of our conveniently located Akins Collision Centers

Direct your referral to communicate that they are part of the Give Back Program.

We pull your registration card and send your program a check for 2% of the total sale upon completion of repairs*

Program Registration Form

*cannot be combined with any other offer