Vehicle Donation Information Form

Instructions: Please complete every field prior to submission. **

Contact Name *

Contact Email *

Contact Phone Number *


Vehicle Identification Number *

Year *

Make *

Body Style *

Model *

Empty Weight (lbs.) *

License Plate Number *

Major Vehicle Color *

Vehicle Inspection Current *
yesno

Date Inspection Expires *

Odometer Reading (Mileage) *


Name on Title


Address on Title Street Address

City, State, Zipcode


Physical Location of Vehicle Street Address

City, State, Zipcode

Kelly Blue Book Value*


**Once this form has been submitted you will be contacted within 5 - 10 business days to schedule an inspection of the vehicle. After inspection and acceptance of the vehicle an appointment will be made for vehicle drop off and document processing at our Title Transfer Office.

Thank you for thinking of the PTSD Foundation of America for your vehicle donation!