Vehicle Donation Form



All section marked by a star must be filled out to process. This form will go to our operators who will call you to confirm your pick-up time. You may set up a pick-up time for any day of the week, 24 hours a day.

Vehicle Donation Form
*Preferred pickup date:
*Preferred pickup time:
*How did you hear about our vehicle donation program?:
Vehicle Information
*Year:
*Make/Model:
*Style:(i.e. 2-Door, 4-Door, LS, RS...)
*Mileage:
Color:
*License Plate #:
*VIN #:
*Street Address to pick-up the car:
SAN DIEGO County Addresses Only Please
*City:
*Zip:
Describe General Condition of the Car:
*Is the vehicle running?: Yes    No
If vehicle is running, how well does it run?: Excellent    Fair    Poor
Condition of the Body: Excellent    Fair    Poor
Condition of the Interior: Excellent    Fair    Poor
Does owner have the title?: Yes    No
Is the title in the name of the donor?: Yes    No
Is the car free and clear of liens?: Yes    No
If there is a lien, how much is owed?:
Has it been in any accidents?: Yes    No
Is there a salvaged title?: Yes    No
Contact Information
*Name:
*Email Address:
*Telephone # to be reached at:
Alternative Phone Number:
*Mailing Address:
*City:
*Zip:
Comments: