Massachusetts(801) - Donate

Home
Frequently Asked Questions
About Us
Donation Form
American Lung Association of Massachusetts
Donation Form*
Thank you for choosing to donate to us. Please use the following form to donate your car, boat, RV or other qualifying vehicle. We will contact you via phone or email within four business days to complete your donation request and coordinate the pickup of your donated vehicle.



If you have any questions at anytime during the donation process please contact our knowledgeable customer service staff at 1-800-966-0664.
Vehicle Donation
Personal Information
click here for help
Title*
First name*
Last name*
Suffix
Sr Suffix
Business name
Address type* Home Business Non USA
Address1*
Address2
City*
State*
Zip*
Zip2
Home Phone*
- -
Bus Phone
- -  Ext  
Fax
- -
Email*
Vehicle information
Type*
Make*
Model*
Model Year*  (4 digit year)
Color
# of Doors*
Is it road worthy?* NoYes
Approximate Mileage*
VIN #*
Odometer
 
Any major damage?* NoYes  If yes, description
Location for pick up* use same address
Is the Title Free?* NoYes
Lien Holder? Yes  If yes, lien released
Plates  Plate #
Current Registration?*  If not, last registered
Weight
Comments
 
 
 
 
©2006 Marketing Response Systems - All Rights Reserved.