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*

 

*cannot be combined with any other offer