Owner Information

Name (First and Last):

Street Address:

City:

State:

Zip:

Cell phone:

Daytime Phone:

email address:
(This is required)
Please note: A full email address looks something like this:

JohnJones@aol.com or Janie133@prodigy.net.

Vehicle Information (Be as specific as possible)

Make

Model Description

Year

Approx. Mileage

Plate Number

If this information is not available please email it later.

VIN
(Vehicle Identification Number)

If this information is not available please email it later and also have it available when the towing company calls to arrange pickup.

Condition of body.
Please be as specific as possible.
If there is damage please describe each area that is damaged and how much.

Condition of interior including any damage.
Please be as specific as possible.
Do the inside instruments work?
How is the carpets, seats, dash?

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

Please write here exactly how the name(s) appear on the title.
Please be sure there are no liens (loans) against 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 (street, city, state & zip) here as well as the name and phone number of the contact person if available.)

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Thank you for your participation in Car Donation Child Charity.

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 | Donation Form |