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How to Donate a CAR to
Lupus Alliance - Hudson Valley

Our Car Program will make arrangements to conveniently and quickly pick-up your car donation at no cost to you. The Car Program will also handle the title transfer requirements and provide you with a tax-deductible donation receipt at the time of pick-up!

Please fill out the following form, and Submit it OnLine. The donor will be contacted M-F during working hours, at the given telephone number(s) within 4 working days

Enter your information here
Donor Name   

Number
and Street
(Vehicle Location)
City (Vehicle Location) State    Zip
Telephone
 Area Code   Number 
Alternative Phone Number Area Code    Number 
E-Mail (optional)
Best Time to Contact you

To select multiples, please hold down <CTRL>
Best Day of the week to Contact you

To select multiples, please hold down <CTRL>
Vehicle Information
Year   

Make
Model
License Number
VIN Number
Please check all that apply:
 2-Door ; 4-Door ; Station-Wagon ; 4-Wheel-Drive

Does the vehicle run and
drive as is?

 

 

Yes

If NO, please explain:

Do you have the Title?

 

 

Yes

If NO, please explain:
Please note any problems or damage and explain
Engine
Transmission
Body
Other
Special Instructions
There are no problems

On behalf of all the Patients and Families of Lupus Alliance - Hudson Valley
please accept our sincere gratitude for your kindness.

Final Instructions to complete your Donation

1

On completion of this entire form, please print one copy for yourself.

 

2

Then press the "Submit" button to send us the completed form.

   

Please be patient, it takes a short time to send the submission.

  

 
   
 
 

© 2003 Lupus Alliance-Hudson Valley
PO Box 8240, White Plains, NY 10602

171 East Post Road Room 218, White Plains, NY 10601
(914) 948 - 1032    or   1 (888) 57 LUPUS

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