Get documents about "DONATE YOUR CAR AND CHANGE LIVES
Document Sample
Vehicles For Change Donation Form
Please have the keys, title and lien release (if applicable) ready for the tow company. Use this
check list to prepare:
Sign and print your name on the title as the seller, exactly as your name appears on
the title.
List Vehicle For Change as the buyer on the title. Vehicles For Change will complete
the remaining fields as needed.
Copy or scan both sides of the signed title for your records.
Remove license tags, and return them to the Department of Motor Vehicles before
cancelling the insurance.
Please note: We must have the title to complete your donation. Fill in only the buyer and seller
fields. The Department of Motor Vehicles is very strict about titles. They will not accept titles
that contain errors or have information scratched out.
Please complete the following form and return it to Vehicles For Change. Donation forms may
be faxed, emailed or mailed. You will receive email confirmation when we receive your donation
form. Within 24 hours of VFC receiving your donation submission, a towing company will call
you to schedule a free pick-up. Pick-up is typically scheduled within 3 days (except during
December and early January).
Fax: 410-242-9677
Email: info@vehiclesforchange.org
Mail: 5230 Washington Boulevard, Halethorpe, MD 21227
A receipt for your donation will be sent to you within 30 days of the car’s award or sale.
Questions? Give us a call at 800-835-3821.
On behalf of all Vehicles For Change families, thank you for your donation!
Vehicles for Change Car Donation
Scheduled Pick-Up Date/Time:
(VFC Use Only)
Date:
Contact Information
Name:
Email Address:
Address:
City: State: Zip:
Nearest Cross Street: County:
Home Phone: Cell Phone:
Social Security Number*:
The IRS requires us to collect Social Security Numbers for tax-reporting purposes. This information is kept
confidential. This document will be shredded once it is received by VFC.
Vehicle Location
Please include this information if vehicle location is not the same as residence
Pick-Up Street:
Pick- Up City: Pick- Up State: Pick-Up Zip:
Vehicle Information
Year: Make: Model:
Color: Miles: Vehicle Identification Number:
Stick/Auto 2/4 Door Runs: Yes No
General Condition:
How Did You Hear About Us?
Please circle the one that prompted your donation:
Organization Garage/Repair Shop School
Adventist Hospital Foundation British American Auto Care Calvert Hall High School
Am Kolel Car Dealer Centennial High School
ASHA for Women Precision Tune Georgetown Prep School
Big Brothers Big Sisters Stan Rollison’s Automotive Howard High School
Bike MD Other (please include below): Long Reach High School
Boys & Girls Club - Harford County Mercy High School
Cancer Support Foundation Mt. De Sales High School
Catholic Charities Mt. Hebron High
CEO’s Club North County High School
COMPASS Reservoir High School
Engineering Society Engineers Club River Hill High School
Girl Scouts of Central MD UMBC
Goodwill of the Chesapeake Other (please include below):
Greater Baltimore Committee
Greater Wash. Board of Trade
NCAC Boy Scouts of America
Sponsor agency
Y of Central Maryland
Other (please include below):
Internet Television Radio
Web search ABC 2 (WMAR) 100.7 The Bay
Facebook ABC 7 (WJLA) WBAL
Twitter Fox 5 (WTTG) WMAL
LinkedIn Fox 45 (WBFF) WMZQ
MVA website NBC 4 (WRC) WTOP
Other (please include below): WBAL 11 (NBC) WTVR Lite 98
WJZ 13 (CBS) Other (please include below):
WUSA 9 (CBS)
Other (please include below):
Event Miscellaneous Newspaper/publication
Auto show Freedom Wheels Baltimore Sun
Golf tournament Friend or relative Washington Post
Other (please include below) Local or drop off Other (please include below):
Previously donated
Other (please include below):
For Vehicles For Change Use Only
Towing Company:
Title Rec’d: Y N Keys Rec’d: Y N VIN Verified:
File# County Windshield:
Drop Off : Beltsville Elkridge Carroll Baltimore City
Baltimore Co. Montgomery Northern VA Other:
Thank you: Date/Sender: Initial Evaluation By:
Keep Whole Input: Date/By:
