Vehicle Donation Form

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  First Name (required)
  
  
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  Last Name (required)
  
  
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  Email Address (required)
  
  
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  Street Address* (required)
  
  
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  City (required)
  
  
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  State / Province / Region (required)
  
  
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  ZIP / Postal Code (required)
  
  
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  I would like to receive e-mail from Catholic Charities of BaltimoreI would like to receive postal mail from Catholic Charities of Baltimore
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  Home Phone
  
  
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  Work Phone
  
  
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  Mobile/Other Phone (required)
  
  
• Preferred Contact Number*
  HomeWorkMobile/Other
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  County where vehicle is located* (required)
  
  
• Is vehicle pick-up location different than your mailing address?*
  YesNo
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  Year of the vehicle you are donating* (required)
  
  
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  Make of the vehicle you are donating* (required)
  
  
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  Model of the vehicle you are donating* (required)
  
  
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  Color of the vehicle you are donating* (required)
  
  
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  Mileage* (required)
  
  
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  State where the vehicle is registered* (required)
  
  
• Does the vehicle start?*
  YesNo
• Is the vehicle drivable?*
  YesNo

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  Title Number* (required)
  
  
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  Vehicle Identification Number (VIN)* (required)
  
  
• Are there any liens on the vehicle?*
  Sorry, but we are unable to accept vehicles with liens. You will need to obtain a lien release from your lender if the vehicle was financed, even if it is paid off, if the title is not in your name.
  YesNo
• Where did you hear about our program?*
  Already familiar with Catholic CharitiesChurch bulletinFriend/Family memberSearch engineMailingOur websiteAnother websiteOther

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