Donate Vehicle Form

First Name *

Last Name *

Phone Number: *

Email *

Where is the vehicle currently located (address of the vehicle)? *

Is the vehicle currently operable / drivable? *

If the vehicle is not operable / drivable, why not?

The overall condition of this vehicle is: *

Vehicle Year: *

Make/Model/Style: *

Current Mileage: *

Are all the parts (tires, battery, lights, radio, windows, brakes, etc.) in working order? *

Please list any interior and exterior cosmetic issues (Examples could include: upholstery damage, dents, dings, broken windows/mirrors, etc.) *

Please list any engine, transmission, mechanical, or electrical problems *

Do you have the title: *

Is your name the only name on the title? *

If your name is not the only name on the title, whose name(s) are listed?

Has the vehicle been in any accidents or sustained major damage, including flood damage? *

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