Make-A-Wish® Foundation Vehicle Donation Form

Name:
Address:
City: State: Zip:
Phone #:
I would like to donate my:
Make:
Model:
Year:
Miles:
Mechanical Issues:
Does it run and drive?
We appreciate your generous donation, which will help local children.
Will you please tell us how you heard about our donation program?
We will call you within 24 hours of the next business day to schedule your pickup.
Email Address:
Daytime Phone #:
Best time to call:
Verification:
Validation Code:
*Not Case-Sensitive  
  

We offer free car charity donation pickup or towing from the following states:

Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming