Danielle House

In the spirit of helping others in need, The Danielle House offers a temporary, safe and homelike atmosphere for patients' families and loved ones, and for outpatients seeking respite during a medical crisis, during treatment phases of medical care, or medical related services. Our goal is to provide love, support, comfort, and affordable accommodations for those who find themselves in the Triple Cities area in need of a place to stay.

Vehicle Donation Quotation Form
Please note: By filling out the form below you are not committed to donating your car. Filling out this form will allow us to contact you with a quote on the price the charity of your choice will receive for your vehicle. All personal data is kept strictly private and will never be sold.
Owner Information Section
Name *	State/Province *
	Please select... ---- Canada ---- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---- USA ---- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Address on Ownership *	ZIP/Postal Code *
City *	Phone Number *
Cell Number	Email *
Donating Your vehicle?
Yes, I want to donate my vehicle to Danielle House.
Vehicle Information Section
Year	Make
Model	Mileage
Licence 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) Address* ZIP/Postal Code * City * State/Province * Please select... ---- Canada ---- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---- USA ---- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Condition of vehicle	Comments about vehicle
Please choose one. Working Not Working
There are no liens / loans outstanding against this vehicle.
I do have the ownership / title to transfer to the Authorized Treatment Facility.
Human? Answer this question 4+7=