ONLINE VEHICLE DONATION FORM
(
*
) Required field that needs to be filled out on this form.
Name
*
:
Street
*
:
City
*
:
State
*
:
Zip
*
:
Best / Day Time Phone
*
:
Cell :
Email :
Vehicle Make
*
:
Model
*
:
Year
*
:
Color :
Mileage
*
:
Vehicle ID # (VIN) :
Location of vehicle if different from above, include telephone # and contact person name :
Do you have a title? :
Yes
No
Is the title free and clear of lien? :
Yes
No
Can vehicle be driven 20 miles? :
Yes
No
Does the vehicle have any damage? :
Yes
No
vehicle must be accessible by flatbed tow truck (i.e. driveway)?
Note: The vehicle
MUST
have a title, no liens, and four inflated tires and have a complete engine to be accepted into our program. Please remove license plates and all personal items from vehicle before scheduled pick-up date.
Or if you wish you can contact us at
800-966-0664
and we can process your donation over the phone. Thank you again for your Vehicle Donation to your American Red Cross.
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