Donation Form

 

You may use this form to contact us with questions or to donate your vehicle now. A Vehicle Donation Program representative will call you within 1-2 business days.

Contact Information
First Name:  REQUIRED
Last Name:  REQUIRED
Address:  REQUIRED
City:  REQUIRED
State:
Zip:  REQUIRED
Daytime Phone: ( ) -  REQUIRED
Alternate Phone: ( ) -
E-Mail:

Select a Charity

Vehicle Location
  Check here if vehicle location is
same as Donor address above.
Address:  REQUIRED
City:
State:
Zip:

Vehicle Information
Year:
Make:
Model:
License Plate:
VIN:

Vehicle Information
Damage to Body (Describe):
Damage to Interior (Describe):
Does your vehicle run and drive?
Do you have the Certificate of Title?

Special Instructions & Comments
 
 

We’ll send you an immediate email confirmation that your donation was received and we’ll call you within a few business hours to schedule your free next day pick-up.

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.

 

Easter Seals Vehicle Donation Program #1-888-631-6833
2009-2016 Car Program Inc.