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Vehicle Donation Form

Thank you for your contribution to Eldergivers! Please fill out and submit the form. We will contact you to arrange for a convenient time for our driver to come and pick up your vehicle.

When we pick up your car, we will issue you a receipt on our letterhead which will include the information below, and a high and low Kelley Blue Book estimate of fair market value, which we must give you by law. It will be up to you to confer with your accountant to determine the amount you will take as an income tax deduction.

Date
Last name of registered owner
First name of registered owner
Address
City
State
ZIP
Home phone
(123) 456-7890
Office phone
(123) 456-7890 (optional)
Vehicle Year
Vehicle Make
Vehicle Model
Is it running?
Is there any body damage?
Estimated Mileage
California License Plate No.
Vehicle Identification No. (VIN)