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Donating Cars
 
  First Name*
  Last Name *
  Address*
  Phone No.*
  Alternate Phone
  E-mail Address *
  Address *
  Apt/Suite/Unit
  City*
  State*
  Zip Code    *    
  Is your vehicle at this address?* Yes No
  VIN No.
  Year*
  Make*
  Model*
  Color
  Mileage
  Vehicle Type
  Does the vehicle run?* Yes No
  Do you have the title?* Yes No
  Any problems or damage? Check any that apply.
Front End Side Rear End
Roof Fire Mechanical
Electrical    
  Problem details or special pickup instructions?
   
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