Support MesoRFA

THE FOUNDATION: Vehicle Donation Program

Please complete this form.
As a donor of the vehicle you will be contacted within four (4) business days.

Donor Information:

Name of Owner :
Email Address :
Address :
Address :
City :
State :
Zip :
Daytime Phone :
with Area Code
Evening Phone :
with Area Code

Charitable Organization Choice:

Charity Name :

Vehicle Donation Information: (Skip to next section for boat donations)

Type of Donation :
Year :
Make :
(e.g. Ford, Chevy, BMW, Saturn, etc.)
Model :
(e.g. Taurus, Malibu, etc.)
Color :
Number of Doors :
Vehicle ID# (VIN) :
Title :
Approx. Mileage :
Running :
Condition :
Contact Name :
(if different)
Vehicle Location :
(if different)

Boat Donation Information: (Boat must have clear title and a trailer)

Year :
Make :
Model :
Size :
Type :
Engine Size :
Boat Hull Number :
Trailer :
Trailer VIN Number :
Condition :

Gift in Memory

Commemorate a special person, holiday, birthday, wedding, or other special occassion.

Who would you like to memorialize?

Who would you like to send a memorial card to?

Name (First, Last)

Address

City

State

ZIP Code

Country

Thank You for Your Vehicle Donation