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February 9, 2010

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Vehicle Donation Form

Field marked with a * required fields.
Submitter's Name: *
E-mail Address:
Do you wish to donate your vehicle to support the work of UCP or to one of UCP's local affiliates: *
National Office
Affiliate
Affiliate to which you want to donate your vehicle?:
 Personal Information

Donor's Name(s) as it appears on the the title:

Last Name:

First Name:

Last Name:

First Name:

Company Name:

Current Address:

Cross Street:

City:

State:

Zip:
Please select one: *

Home Phone:

Work Phone:

Cell Phone:

Other Phone:
 Vehicle Location

Is the vehicle located at the above address?

  If not, indicate vehicle location below

Location name:
 (i.e. private residence, Smith's Repair Shop, etc.)

Current Address:

City:

State:

Zip:

Contact Person:

Contact Phone:
 Vehicle Information

Year:
Make:
Model:
VIN:
Number of Doors:
Color:
Mileage:
Does your vehicle run? 

To maximize the value from the sale of your vehicle, could you describe:

Condition of Interior:
Condition of Exterior:
Mechanical Condition
(please elaborate):
Do you have keys?

How do you rate the tires? 

Are the tires inflated?

Does the vehicle have a battery?

Is vehicle accessible to tow truck and not parked in garage or grassy area? 

Title number:

Title state:

Title Control Number:

Is there or has there ever been a lien on the vehicle?

When your vehicle is picked up by our towing company, where would you like us to leave the receipt? (Example: mailbox, under door, mail to me).
On the front of the title, if there is a financial institution listed, you will be required to have a lien release
 Other Information

How were you referred to UCP?:

We welcome your comments in the space below.
Yes, I am interested in receiving updates on UCP's work via e-mail?


 


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