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If you would like to donate your old car, but feel unsure or nervous
about starting the process, we take the worry out of donating.

Thank you for your inquiry about donating your vehicle.  Please be assured that all of your questions and concerns will be addressed prior to any action taking place.  All information on this form is ONLY used for the purposes of this donation.  This information is not given to anyone for any other purpose.


Car Donation Owner Information:

Your First and Last Name:
Address:
City:
State:   ZIP:
Cell phone:
Daytime phone:

Your Email address:

Required

Car Information: (Be as specific as possible).

Make:
Model Description:
Year:
   
Approximate Mileage?
Vehicle License Plate:
If number not with you see next red note.
VIN (Vehicle Identification Number): Can be found on the Certificate of Title.

If the license plate number and/or the Vehicle Identification number is not available at the time you fill in this form please email it later.

Exterior Condition Please fully describe the condition of the exterior (Paint, rust, dents, damage, broken parts). If there is any damage please provide full details about which parts are damaged and how much damage:

Interior Condition Please describe the condition of the interior (upholstery, carpets, instrument panel, a/c working etc.). If any damage or non functioning parts please describe.

Does the vehicle run/drive well? (If not, please describe why.) When was the vehicle last driven?

Certificate of Title - Please do check to see if you have the Certificate of Title. Please write here exactly how the name(s) appear on the Title. Please check to be sure the title has no liens (loans) against it.

Registration Is your registration (the yearly fee you pay to the state) current?  If not, what year did you last pay your registration fee to the state?

Location of Vehicle, Phone Number & Contact Person. If the location of the vehicle is different than the above address, please provide the full address including zip code and phone number (if there is one) and the name of any contact person at this location.

Special instructions or Comments.

Instructions for Donating a vehicle:

NOTE: Do not use the ENTER key after typing in data. In some fields that submits the form.

PLEASE fill out this form in its entirety. By doing so, it will make the process faster and easier. This will only take a few minutes. By providing all of the information we can start the donation pick up process immediately.

If you have questions or want more information about making a donation you can put your questions on the donation form in the Comments Section towards the end of the form.

Thank you for your inquiry and for your concern about helping improve the economic security and family well-being through car ownership.  A representative from our agency will contact you shortly to answer your questions; and, if appropriate, begin the donation process.
 


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