Donate Vehicle Form

Donor Name: *

Home Phone: *

Mobile Phone: *

Email *

Does this vehicle currently run and is it drivable?: *

Year: *

Make/Model/Style: *

Mileage: *

The overall condition of this vehicle is: *

Is there any interior damage? If so, please list the damages: *

Is there any exterior damage? If so, please list the damages: *

Are there any engine problems? If so, please describe: *

Are there any transmission problems? If so, please describe: *

Are there any other mechanical problems? If so, please describe: *

Do you have the original title: *

Is the name on the title the same as the person donating the vehicle?: *

If there is a loan, do you have the release of lien from the lender?: *

Are there valid tags on the vehicle?: *

When was the vehicles last inspection?: *

Does this vehicle have any flood damage or major accidents in its history?: *

Triangle Residential Options for Substance Abusers, Inc. (TROSA) is a 501(c)(3) charity. Tax ID / EIN #: 56-1861158