Vehicle Donation

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

VIN#:*

Year:*

Body Style*

Make*

Model*

Empty Weight (lbs)

License Plate #*

Primary Color*

Vehicle Inspection Current?*

YesNo

Date Inspection Expires

Date

Odometer Reading (Mileage)*

Kelly Blue Book Amount (Dollar Amount)

If you would like to claim the full value of your vehicle donation, please check the box below to enter your social security number.

I would like to claim the full value of my donation.

If you decide not to claim the full value of your vehicle, IRS guidelines state that you are only allowed to claim $500.

Please Enter Your Social Security Number:*

By entering your Social Security Number, you acknowledge that a Form 1098 will be sent to you within 30 days of your donation via certified mail or fedex, which you can use to claim your donation on your annual taxes.

Is the vehicle in good working order?*

YesNo

Do you have any restrictions for the use or disposition of the vehicle?*

YesNo

Please list restrictions:

Is the vehicle wrapped or does it have any kind of insignia that needs to be removed?*

YesNo

Are you willing to remove or pay to have it removed before donating the vehicle? Please note that a vehicle cannot be donated to a veteran until all wraps or insignias are completely removed.*

YesNo

Vehicle Donation

Vehicle Information

Title Information

Location of Vehicle