Owner Information

Your Name (First and Last):

Street Address:

City:

State:

Zip:

Cell phone:

Daytime Phone:

Email Address:
(This is required.) Please double check that it is correct.

A full email address looks something like this: JohnJones@aol.com or Janie133@prodigy.net.

Vehicle Information

Make

Model Description

Year

Approx. Mileage

Plate Number

If number not with you see next red note.

VIN
(Vehicle Identification Number)

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 and have it ready when the towing company calls to arrange pickup.

Condition of body including any damage.
Please be as specific as possible.

Condition of interior including any damage.
Please be as specific as possible.

Does the vehicle run/drive well? (if not, please describe what is known about its running condition.)

Please write here exactly how the name(s) appear on the title.

Is your registration current? If not, what year did you last pay your registration fee?

Location of vehicle & contact person.

(Please note, if your vehicle is in a different location than your above address, please give that address here as well as the name and phone number of the contact person if available.)

We do not pick up in Florida, Mississippi or Iowa.

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Thank you for your participation in Car Donation Charities.

We will process your form and then you will be contacted very soon by email.

Please stay alert for email responses.

If you have any difficulty with this form you can use any of the following car or vehicle donation forms:

| Donation Form |Donation Form | Donation Form |