American Auto Donors - Help the Lions Club today!

Name
First Name:
Last Name:
Phone:
Phone(Alternate):
E-mail Address:
Address
Address:
City:
State:
Zip Code:
Vehicle Location
(if different from above)
Address:
City:
State:
Zip Code:
Vehicle Information
Year:
Make:
Model:
License:
VIN Number:
Present Mileage:
Does the vehicle run?	Yes
	No
Do you have the title?	Yes
	No
Damage to the body: (Describe)
Interior Damage:
Describe any other problems:
Any special instructions?

If you have any difficulty with this form or want to speak with a representative immediately, then please call us toll-free at 1-866-5DONATE.