Donation Form:

If you are donating a registered or titled vehicle,
please fill out the donor information exactly as it appears on the registration or title.

  • If a "/" (slash) or the word "and" appears between both names on the title then both parties must sign the title and any other documents required.

  • If the word "or" appears then either party can sign.

  • Owner(s) must be present at the time of pick-up.

Donor Information
  * Name:

 * Address:

 * City:

   * State:    * Zip: -

* Home Phone # 

          Work Phone #         Email

Best Time to Call:

   Other:

Vehicle Information
* Year:

Color:

* Make:

* Exterior Condition:

* Model

* Interior Condition:

*  #Doors:

* Mileage:

* Have Keys:

* Running:

License Plate #

* How Long Sitting:

* Tires Inflated:

*  Plate State:

* Vehicle Intact:

* Radio:  

Non profit to doniate to:

* Tape:  

 

* CD:  

* A/C:  

* Security System:  

   

* Is your vehicle registration current?

   

Do you know what mechanical problems this vehicle has?  Please explain, if any  (engine, transmission, brakes, clutch, differential, tires, etc...) 

 

Do you know what body damage this vehicle has?  Please explain, if any  (paint, rust, dents, corrosion, etc...) 
   

Does the interior have any damage?   Please explain, if any  (seats, dashboard, carpet, door panels, headliner, etc...)
   
* Title:

* Is Title in Donor's Name:

* VIN:

* Is Registration Current:

     
Vehicle Address:

Vehicle City:

  State:    Zip: -

Charity Information (optional)
Donate To:

(Please type the name of the Charity you wish your vehicle be donated to)
Charity Address:

City:

   State:    Zip: -

Charity Phone #

        Contact:

How did you hear of us?

*

 

If other, please specify: