Cousineau Auto Inc. Charity Car Program

Cousineau Auto Inc., Appleton, WI Charity Car Donation Quotation Form
 

For more than 50 years, Cousineau Auto Inc has been serving customers in Wisconsin and surrounding states with quality recycled parts. Locally owned and operated. Cousineau Auto is a trusted name in recycled parts.

Cousineau Auto Inc. 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 private and will never be sold.
 
Owner Information Section
Name * State/Province *
Address on Ownership * ZIP/Postal Code *
City * Phone Number *
Cell Number Email *

Donating Your vehicle?
Yes, I want to donate my vehicle.
Select One of Our Participating Charity Partners From The List Below:

Or Type The Name Of Your Own Favorite Charity In The Space Below:
Type Your Favorite Charity Name Here: 

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)
Condition of vehicle Comments about vehicle
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=