Car Donation Form

Cars for Christ Donation Form

GENERAL INFORMATION: Enter the name of the individual whose name should appear on the tax receipt that you will receive for the donated vehicle. We also need your phone number so that we can contact you to make an appointment for the pickup of your vehicle.

* First Name

* Last Name

* Street Address, City, State & Zip Code

Daytime Phone:

* Email Address

VEHICLE LOCATION (if different from above). If the vehicle is at the same location as above, please do not fill out this section:

Street Address, City, State & Zip Code

VEHICLE INFORMATION: Please enter the year, make and model of your vehicle.

* Year:

* Make:

Model:

Approximate Mileage:

* Does the vehicle run?

* Do you have a title for the vehicle?

* VEHICLE CONDITION:

OTHER INFORMATION: Are there any problems with the vehicle that you are aware of? If so, please specify. Does the vehicle have any accident damage or rust? Please describe any problems with the vehicle:

SPECIAL INSTRUCTIONS: Please let us know if you have a preference for pickup times or dates, or if there are any other details about arranging the pickup that we should know. Thank you!

* Indicates Response Required

	Poor	Fair	Good	Excellent
Interior Condition
Exterior Condition
Mechanical Condition