Cars for Christ®

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Fill out the Pick Up Request, submit it and we'll do the rest.

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Sorry, we can not accept vehicles that:

     Have wheels missing
     Missing the title for 1986 model or newer
     Have a lien against it
     Are not legally in your name

Pick Up Request

Personal Information

Your Name:

Address:

City:

State: Zip Code:

Phone Number:

(000-000-0000)

Fax Number:

(000-000-0000)

E-mail Address:

Vehicle Information

Make:

Model:

Year:

Color:

VIN:

Title #:

Title:

N/A for 1985 model or older

Keys:

Sets:

Running Condition:

Exterior Condition:

Vehicle Pick Up Location

Pick Up Urgency:

Address:

City:

State: Zip Code:

Contact Name:

Contact Phone: (000-000-0000)

Special Instructions:

By submitting this form, I certify that information contained in this request is true and complete. I understand that willfully submitting false information may constitute a fraudulent act and be in violation of local, state and/or federal law. I authorize the verification of any or all information listed above.