Queens Sickle Cell Advocacy Network,INC

Queens Sickle Cell Advocacy Network,INC, Queens Village,NY Vehicle Donation Quotation Form
 

QSCAN is a 501(c)(3)non-for-profit broad based organization, Serving children,families and Individuals with Sickle Cell Disease, Thalassemia and the Trait. Sickle cell disease affected over 100,000 people in the USA and over 2.5 million global. Help us help families in need.

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 *
Address on Ownership * ZIP/Postal Code *
City *
Daytime Phone Number * Phone/Cell/Work Number *
Email *

Donating Your vehicle?

Yes, I want to donate my vehicle to Queens Sickle Cell Advocacy Network,INC.

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
*
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=