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.





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*


*cannot be combined with any other offer