Komen Cars Sign-up Form

Komen Cars Donation Program Sign-up

Thank you for your interest in the Komen Cars Donation Program. Today there are over 80 Komen Affiliates presently participating in the program. The get your Komen Affiliated signed-up in the program, please complete the below:

Komen Affiliate: *

Komen Affiliate Address: *

Komen Affiliate City: *

Komen Affiliate State: *

Komen Affiliate Zip Code: *

Federal ID Number (EIN): *

Komen Affiliate Website: *

Komen Affiliate Point of Contact Name: *

Komen Affiliate Point of Contact Title: *

Komen Affiliate Point of Contact E-mail Address: *

Komen Affiliate Point of Contact Telephone Number: *

Komen Affiliate Point of Contact FAX Number:: *

Comments:

Also, Please fax your IRS 501c3 designation letter to us at 1-877-303-4936.

Upon receipt we will be in contact with you to get the ball moving.

Again, thanks for your interest in the Komen Cars Donation Program.

I can also be contacted at 301-856-6340

Ron Farrin, Director Call Center Operations