Donation Form

 

You may use this form to contact us with questions or to donate your vehicle now. Either way,  a Car Donation Program representative will contact you within 3-4 business days at the latest.

First Name

(Required)

Last Name

(Required)

Phone

( ) (Required)

E-Mail

 Select a Chapter:
Vehicle Location

Address

City

State

Zip

Vehicle Information

Year


Make


Model


License


VIN


Damage to Body (Describe):


Interior Damage:


Does the vehicle run/drive?


Title Paperwork:


Special Instructions or Other Comments:


Thank you!

If you have any difficulties with this form or wish to speak with a representative immediately, please call our Customer Service Center toll-free at 1-888-631-6833.

 

© 2001 Car Program LLC  Easter Seals Vehicle Donation #1-888-631-6833