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Vehicle Donation Form



Thank you for your interest in donating a vehicle to the Alzheimer's Association Donate-A-Car Program, which helps fuel our mission-related initiatives of Alzheimer's care, support and research. Please fill out this online form to donate your car, truck, boat, trailer or RV. If you have any questions, take a look at our FAQs, email us at donateacar@alz.org or call the Donate-A-Car processing center toll-free, seven days a week at 800.240.0160.

DONOR INFORMATION

* First Name:

* Last Name:

* Email:

* Address:

* City:

* State:

* ZIP

* Phone Number:



VEHICLE LOCATION

If your vehicle is located at the same address listed above, check this box; if not, fill out the below fields.   Yes  

Vehicle Address:

Vehicle City:

Vehicle State:

Vehicle ZIP:



VEHICLE INFORMATION

Vehicle Year:

Vehicle Make:

Vehicle Model:

License Plate Number:

Vehicle Identification Number:



Is there any damage to the body? If so, please describe:

Is there any damage to the interior? If so, please 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: