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DONOR Information:
First Name *
Last Name *
E-mail *
Home Phone *
Work/Cell Phone
Home Address *
Donate to Charity
...
A Lift Up
Adopt a Rescue Pet
American Red Cross
Big Brothers Big Sisters
Catholic Charities
Disabled Veterans of America
F.L.O.C.K.
Goodwill
Jewish Family Services Agency
Jewish Federation of Las Vegas
Keepers of the Wild
Las Vegas Senior Lifeline
Leids Animal Shelter
Miracle Flights for Kids
Nevada Paralyzed Veterans
Nevada S.P.C.A
Opportunity Village
Positively Kids
Reading Fundamentals
Safe Nest
Shade Tree Shelter
Vehicle Donations Processing
Women's Resource Center
TITLE Information:
Are you in possession of the title?
yes
no
Is there a lien holder?
yes
no
Has the lien holder signed the title?
yes
no
VEHICLE Information:
VIN
Year *
Make *
Model *
Body *
Sedan
Coupe
SUV
Van
Mini-Van
Pickup
Utility
Wagon
Motorcycle
Commercial
other
Color *
Runs? *
yes
no
Keys? *
1 set
2 sets
missing
Flat/Missing Tires? *
none
front
back
all
PICK UP Information:
Pick up as soon as possible
- we will call you for available pick up time
Pick up Date Requested *
Pick up Time Requested *
...
first available
5AM - 7AM
7AM - 9AM
9AM - 11AM
11AM - 1PM
1PM - 3PM
3PM - 5PM
5PM - 7PM
7PM - 9PM
9PM - 11PM
11PM - 1AM
Same as Home Address
Pick up Address *
Parking Location *
DONATE YOUR VEHICLE ONLINE
Donating your vehicle is a great way to raise money for charity, and a simple way to earn
a $500 or more tax deduction
for your next tax return!
Help your favorite charity today!
Please call us with any questions:
702 438 3028
You can also donate over the phone
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email
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