Vehicles For Change Donation Form
Please have the keys, title and lien release (if applicable) ready for the tow company. Use this
check list to prepare:

Sign and print your name on the title as the seller, exactly as your name appears on
the title.

List Vehicle For Change as the buyer on the title. Vehicles For Change will complete
the remaining fields as needed.

Copy or scan both sides of the signed title for your records.

Remove license tags, and return them to the Department of Motor Vehicles before
cancelling the insurance.
Please note: We must have the title to complete your donation. Fill in only the buyer and seller
fields. The Department of Motor Vehicles is very strict about titles. They will not accept titles
that contain errors or have information scratched out.
Please complete the following form and return it to Vehicles For Change. Donation forms may
be faxed, emailed or mailed. You will receive email confirmation when we receive your donation
form. Within 24 hours of VFC receiving your donation submission, a towing company will call
you to schedule a free pick-up. Pick-up is typically scheduled within 3 days (except during
December and early January).
Fax: 410-242-9677
Email: info@vehiclesforchange.org
Mail: 5230 Washington Boulevard, Halethorpe, MD 21227
A receipt for your donation will be sent to you within 30 days of the car’s award or sale.
Questions? Give us a call at 800-835-3821.
On behalf of all Vehicles For Change families, thank you for your donation!
Vehicles for Change Car Donation
Scheduled Pick-Up Date/Time:
(VFC Use Only)
Date:
Contact Information
Name:
Email Address:
Address:
City:
State:
Zip:
Nearest Cross Street:
County:
Home Phone:
Cell Phone:
Social Security Number*:
The IRS requires us to collect Social Security Numbers for tax-reporting purposes. This information is kept
confidential. This document will be shredded once it is received by VFC.
Vehicle Location
Please include this information if vehicle location is not the same as residence
Pick-Up Street:
Pick- Up City:
Pick- Up State:
Pick-Up Zip:
Vehicle Information
Year:
Make:
Model:
Color:
Miles:
Vehicle Identification Number:
Stick/Auto
2/4 Door
Runs: Yes
No
How Did You Hear About Us?
Please circle the one that prompted your donation:
Organization
Adventist Hospital Foundation
Am Kolel
ASHA for Women
Big Brothers Big Sisters
Bike MD
Boys & Girls Club - Harford County
Cancer Support Foundation
Garage/Repair Shop
British American Auto Care
Car Dealer
Precision Tune
Stan Rollison’s Automotive
Other (please include below):
School
Calvert Hall High School
Centennial High School
Georgetown Prep School
Howard High School
Long Reach High School
Mercy High School
Mt. De Sales High School
Catholic Charities
CEO’s Club
COMPASS
Engineering Society Engineers Club
Girl Scouts of Central MD
Goodwill of the Chesapeake
Greater Baltimore Committee
Greater Wash. Board of Trade
NCAC Boy Scouts of America
Sponsor agency
Y of Central Maryland
Other (please include below):
Mt. Hebron High
North County High School
Reservoir High School
River Hill High School
UMBC
Other (please include below):
Internet
Web search
Facebook
Twitter
LinkedIn
MVA website
Other (please include below):
Television
ABC 2 (WMAR)
ABC 7 (WJLA)
Fox 5 (WTTG)
Fox 45 (WBFF)
NBC 4 (WRC)
WBAL 11 (NBC)
WJZ 13 (CBS)
WUSA 9 (CBS)
Other (please include below):
Radio
100.7 The Bay
WBAL
WMAL
WMZQ
WTOP
WTVR Lite 98
Other (please include below):
Event
Auto show
Golf tournament
Other (please include below)
Miscellaneous
Freedom Wheels
Friend or relative
Local or drop off
Previously donated
Other (please include below):
Newspaper/publication
Baltimore Sun
Washington Post
Other (please include below):
For Vehicles For Change Use Only
Towing Company:
Title Rec’d:
Y N
File#
Keys Rec’d:
Y N
VIN Verified:
County
Drop Off : Beltsville
Baltimore Co.
Windshield:
Elkridge
Carroll
Baltimore City
Montgomery
Northern VA
Other:
Thank you:
Date/Sender:
Keep
Whole Input: Date/By:
Initial Evaluation By: