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Victim's Assistance of America, Inc.


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Victim's Assistance of America, Inc. (VAA)
CAR DONATION FORM

Please use the following form to donate your car, boat or RV. Our towing company and our customer service department will contact you via telephone within four business days at the latest.

**You MUST be the owner named on the title of this vehicle to donate.

If you have any questions you would like answered previous to initiating the donation process, please contact us instead of using this form. Or, if you prefer to speak with a customer service representative, please feel free to call us at 1-502-292-2456 seven days a week. Our [ PRIVACY POLICY ]

If you prefer to print from a WORD document (a blank copy of what this form input produces) -- Please select the following link:

VAA VEHICLE DONATION FORM

ALL FIELDS ARE REQUIRED
FIRST NAME
LAST NAME
ADDRESS
APT/SUITE/LOT
CITY
STATE
ZIP CODE
EMAIL ADDRESS
Contact Telephone (Format: 123-456-7890)
The Charity to Receive the Proceeds of this Donation is
Victims Assistance of America, Inc. (VAA)
VEHICLE ADDRESS (Physical Location)
VEHICLE CITY
VEHICLE STATE
* Michigan residents need to contact the charity directly to pledge their donation.
VEHICLE ZIPCODE
VEHICLE YEAR
VEHICLE MAKE
VEHICLE MODEL
LICENSE PLATE (California Only)
VIN (VEHICLE IDENTIFICATION NUMBER)
ODOMETER READING
(current mileage - if known)
VEHICLE BODY DAMAGE
(Please Describe Any Damage)
VEHICLE INTERIOR CONDITION
(Please Describe Any Damage)
DOES THE VEHICLE RUN AND DRIVE?
Yes No
If the vehicle does not run/drive, please explain in the comment/instructions section below.
DO YOU HAVE THE CERTIFICATE OF TITLE IN YOUR POSSESSION?
Yes No
If title is not in your possession, please explain in the comment/instructions section below.
SPECIAL INSTRUCTIONS OR OTHER COMMENTS

Upon submission, please print your Vehicle Donation Receipt (this is your official receipt) and select the link (www.victimsassistanceofamerica.org) at the bottom of your receipt to return to the VAA website. You will receive an unofficial copy via email shortly after your submission.

VAA appreciates your donation. Thank You!

If you have any difficulty with this form or wish to speak with a customer service representative, please call us at 1-502-292-2456.

Car Donation Information is Courtesy of Car Program LLC

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