Request form to donate your car

Please note: By filling out the form below you are not committed to donating your car. Filling out this form will allow us to contact you with a quote on the price the charity of your choice will receive for your vehicle. All personal data is kept strictly private and will never be sold.
Owner Information Section
Name * Province *
Street Address * Postal Code *
City * Phone Number *
Cell Number Email *

Select One of Our Participating Charity Partners From The List Below:

Or Choose your own favorite Registered Charity:

Please type the name of the Licensed Charity, if not above.

Vehicle Information Section
Year Make
Model Mileage
Asking Price
If your vehicle is located at a different address from your home address, please check the box and then complete the following section, if same as home address (skip)

Condition of vehicle Comments about vehicle
There are no liens / loans outstanding against this vehicle.
I do have the ownership /registration.
Human? Answer this question 4+8=