Effective November 18, 2022

DO NOT USE THIS FORM

This Form Has Been Discontinued

It Will Not Be Received or Processed

Please contact your charity to donate

Charities seeking information contact their car donation service provider.

Effective November 18, 2022

DO NOT USE THIS FORM

This Form Has Been Discontinued

It Will Not Be Received or Processed

Please contact your charity to donate

Charities seeking information can contact their car donation service provider.

Phillips Programs Car Donation Program

Online Vehicle Submission Form

Please complete this simple on-line form for the fastest and easiest way to donate your car. It takes only a couple of minutes to complete and your car donation will be processed immediately.

Once you hit the "Submit" button, you will receive an e-mail notification, normally within hours. Our local towing agency will call you within 24 hours to make any towing arrangements before picking up your donated car.

We value your personal privacy and we will NOT sell, loan, or give your personal information to a third party company except for the sole purpose of processing your car donation.

In order to complete the following, you must have your original vehicle title and, if applicable, lien release.

Submitter's Name: *

Submitter's Email Address: *

Name as it appears on title:

Last Name:

First Name:

Last Name:

First Name:

Company Name:

Current Address:

Cross Street:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Is the vehicle located at the above address:

If not, indicate car or vehicle location for free towing or pickup. Location Name (i.e. private residence, Smith's Repair Shop, etc.)

Current Address:

City:

State:

Zip:

Contact Person:

Contact Phone:

Vehicle Information

Year:

Make:

VIN:

Model:

# Doors:

Mileage:

Color:

Does your car or vehicle run:

Yes

To maximize the value from the sale of your vehicle, could you describe:

Condition of Interior:

Condition of Exterior:

Mechanical Condition (please elaborate):

Help prepare us to tow your car or vehicle:

Do you have keys?

How do you rate the tires?

Are the tires inflated?

Does the vehicle have a battery?

Is vehicle accessible to tow truck and not parked in garage or grassy area?

Title Number:

Title State:

Title Control Number:

Is there or has there ever been a lien on the vehicle?

On the front of the title, if there is a financial institution mentioned, you will be required to have a lien release.

When your vehicle is picked up by our towing company,
where would you like us to leave the receipt?
(Example: mailbox, under door, mail to me)

How were you referred to Phillips Programs?

We welcome your comments in the space below.

Report abuse

Effective November 18, 2022

DO NOT USE THIS FORM

This Form Has Been Discontinued

It Will Not Be Received or Processed

Please contact your charity to donate

Charities seeking information contact their car donation service provider.

Effective November 18, 2022

DO NOT USE THIS FORM

This Form Has Been Discontinued

It Will Not Be Received or Processed

Please contact your charity to donate

Charities seeking information can contact their car donation service provider.