MCCC - The Hourglass Foundation

"*" indicates required fields

Can you tell us how you heard about our Vehicle Donation program?

Do you have a tracking number associated with a donation referral program ? (If not, please input N/A)

What is the Year, Make, Model of the vehicle being donated?*

Please list the VIN#

Color of Vehicle

What is the ACTUAL mileage on the vehicle you're donating? Please do not estimate.*

Is the Vehicle Drivable? (We accept vehicles in any condition)*

Yes

Please describe the general condition of the vehicle you are donating.*

Do you have possession of the vehicle title?

Yes

Please attach a copy of the title.

Accepted file types: jpg, gif, png, jpeg, pdf, heic, Max. file size: 256 MB.

Vehicle Owner Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Phone

Contact Email

Is the pick up location the same as the vehicle owner's address above? Yes/No. If no please list it below.*

Yes

Vehicle Pickup Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Contact Phone

Contact Email

Donor/ Vehicle Owner Name (as it appears on the vehicle title):*

First Last

Is the donor's address the same as the vehicle owner's listed above? Yes or No. If no, please list it here.*

Yes

Donor's Address

Street Address Address Line 2 City State ZIP Code

Please describe the general condition of the vehicle and any additional notes you wish to include.

Please list the last 4 of the donor's social security number. If the vehicle is jointly owned, list one donor's social security number.*

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Comments

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