Car Donation Form Donate Now Please enable JavaScript in your browser to complete this form.Donor InformationName *FirstLastEmail *Contact Phone Number *AddressAddress Line 1Address Line 2CityState/ ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVehicle InformationYear *Make *Model *ModelDXEXLXOtherCar License # *VIN # *Please check all that apply2-Door4-DoorSedanCoupeStation Wagon4-Wheel DriveHatch BackSports UtilityOdometer Reading *ColorTransmissionAutomaticManualDoes the vehicle run and drive as is?YesNoIf No, please explainDoes the car require any repairs?YesNoIf Yes, please explainRepairs performed (to date), please explainVehicle ConditionExcellentGoodFairPoorVery PoorBody DamageFrond EndRear EndDrivers SidePassenger SideRustProblems EngineTransmissionInteriorTiresOtherDo you have the Title?YesNoIf No, please explainIs the car currently registered?YesNoIf Yes, when will the registration expire?MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYearSpecial Instructions (if any):Submit