Applicant Information
VFD Information
if applicable
Contact Information
Organization Information
Counties Served
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Application
Additional Information
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Certification of Application
I understand by submitting this application that the VFD is not guaranteed a vehicle donation from Medina EC. 

I am also certifying that this application is complete and the information provided is complete and accurate.

I understand that if the VFD I am representing does receive a vehicle donation that the:
  • Requesting VFD must assume all liability for the fitness for duty and usefulness of the donated vehicle to the operation of such entity
  • Requesting VFD accepts vehicle in “as-is” condition with no warranty conveyed
  • Requesting VFD assumes responsibility for all tax, title and license impact of donated vehicle
  • Requesting VFD cannot use the donated vehicle for the purposes of fundraising and/or raffling
  • Requesting VFD must give consent to allow a photograph and/or video of the donation with at least one member of the VFD
  • Requesting VFD must give consent to media presentation of donation
  • If awarded a truck, a required five-year waiting period is required before the VFD can be considered for a truck donation
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