Application to Receive a Donated Car
Please fill out the following information to apply for free car.
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City and /County
State
Postal / Zip Code
Choose all that apply
Veteran
Disabled
Homeless
Single Head of Family
Tell us why you should receive a free used car.
Requirements: (click all that apply)
I Have a Valid Driver's License
I Can Afford the Registration fees
I Can Afford Car Insurance
I Can Drive a Manual Transmission
I Currently Own a Car
Annual Income (include all income)
Before Taxes
Number of Household Members
Upload Drivers Licence, and proof of income, DD214 (Veterans ONLY)
Browse Files
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Choose a file
Application will not be considered if documents are not provided
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