Vehicle/Vessel Donation Form

 

Please use this form to donate your car, truck, boat, trailer or RV.  If you have any questions you would like answered previous to initiating the donation process, please feel free to email or call toll-free at 1-217-671-0419 seven days a week.

 

 

Donor Information:

 

         First Name   REQUIRED

 

         Last Name   REQUIRED

 

              Address   REQUIRED

 

                     City   REQUIRED

                                       

                   State           Zip   REQUIRED

 

  Daytime Phone  (  )  - REQUIRED

 

 Alternate Phone (  )  -  

 

               E-Mail 

 

 

Your Donation Will Go To Help:

 

 

 

Vehicle Location:

 

    Check here if vehicle location is same as Donor address above.

 

            Address 

                   City 

 

       State & Zip   

 

 

Vehicle Information:

 

                 Year 

               Make 

              Model 

   License Plate 

                  VIN 

 


Damage to Body (Describe):

 

 

Damage to Interior (Describe):

 

 

Is your vehicle drivable as is?  If not, please explain.

 

 

Do you have the Certificate of Title?  If not, please explain.

 

 

Special Instructions or Other Comments:

 

 

 

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