Owner Information Section

Name *

State/Province *

Address on Ownership *

ZIP/Postal Code *

City *

Daytime Phone Number *

Phone/Cell/Work Number *

Email *

Donating Your vehicle?

Please let us know if you want to receive cash or donate your vehicle.

Yes, I want to donate my vehicle.
No. I want to recycle my vehicle for its cash value.

We will process donations to Licensed Charities. Charities that we are directly associated with:

Please select the name of the Licensed Charity you want to send your funds to.

Vehicle Information Section

Year *

Make *

Model *

Mileage

License Plate

VIN #

If your vehicle is located at a different address from your home address, please check the box and then complete the following section, if same as home address (skip)

Condition of vehicle

Comments about vehicle

Are there any liens/loans outstanding on the vehicle. *

I do have the ownership / title to transfer to the Authorized Treatment Facility.

Vehicle Images Section
Uploading images will help us to better determine the value of your vehicle, possibly increasing what we will pay for your car.

Human? Answer this question 4+7=