IslamiCity.com - Car Donation Form

Car Donation

Make a Difference

*Tax Deductable *Quick Free Pick-Up
*No Paperwork Hassle *Good Deed

Have question or problem,
please call 310-642-0006 x120

Donation Form (Items with * are required)
First Name: *
Last Name :*
Address 1 :*
Address 2:
City: *
County:
State: *
Zip: *
Phone: *
Second Phone:
Best Time to Call:
Email: *
Comments:
Additional Information About Your Vehicle To help us process your donation, please provide the information below.
Year of Vehicle:
Make of Vehicle:
Model:

Vehicle Type:	Car Truck Boat Motor home Trailer

Vehicle Specifics:	2 Door 3 Door 4 Door

Cylinders:	4 Cylinder 6 Cylinder 8 Cylinder

License Plate Number:
VIN:
Vehicle Mileage:
Is the Vehicle Drivable?	Yes No
Does the Vehicle Start?	Yes No
Vehicle Complete?	Yes No
Vehicle Color:
Title State:
Pink Slip/Title Available:	Yes No
Keys Available:	Yes No
Flat Tires:	Yes No
Damage:
Condition Statement/Other Info:
SPAM REDUCTION CODE:	Please enter 102 in the box above.

Islamic Outreach Services, A HADI Project, P. O. Box 4598, Culver City, CA 90231, U.S.A.
Tax ID# 95-4348674. All donations are tax-deductible.