Toll Free: 1-888-800-1695 Local: 1-954-915-3002 donate@chariots4charity.com 2929 E Commercial Blvd Penthouse A-B Ft. Lauderdale, FL 33308

Thank you for choosing to donate your vehicle! A percentage of the net proceeds of your donation will be donated to the charity or charities you choose from the list below. The remaining proceeds are used to operate the Chariots 4 Charity mission of providing safe and operable vehicles to those in need of transportation means. Chariots 4 Charity is not connected with or affiliated with these charities in any form other than the monetary donations we provide. You will receive a donation receipt directly from Chariots 4 Charity. Donate Now! Please note: Fields marked with an * are required Please check the charity or charities you would like to donate your vehicle to. Please note: If you choose multiple charities, the proceeds will be evenly disbursed. Alzheimer's Association American Lung Association AmeriCares Autism Speaks Big Brothers Big Sisters Boys & Girls Club_Of Palm Beach Chariots 4 Charity Children's Miracle Network Cooperative Feeding Program Covenant House Florida Diabetes Research Institute Disabled American Veterans Easter Seals Of South Florida Exchange Club Florida Lions Eye Bank FreeGirl Foundation Habitat For Humanity Intrepid Fallen Heroes Fund Jewish Federation_Palm Beach Kids In Distress Inc Majic Children's Fund Make A Wish Foundation National Alliance to End Homelessness National Cervical Cancer Foundation Nature Conservancy Neighbors 4 Neighbors Nicklaus Children's Health Care Foundation Operation Smile Pace Centers Red Cross Ronald Mc Donald House Rotary S FL Chapter National MS Society Salvation Army Shriner's Hospital St Jude Children Children's Research Hospital St Vincent De Paul Society Susan G. Komen for the Cure United Cerebral Palsey United Way Yellow Ribbon Fund Zoological Society Of Florida     Other (please specify below) * Donor Name: Pick-up location address: City: State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N. Carolina N. Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island S. Carolina S. Dakota Tennessee Texas Utah Vermont Virginia W. Virginia Washington Wisconsin Wyoming Other Zip/Postal: * Telephone Number: Alt. Telephone Number: E-mail Address: * Vehicle Type: Select Vehicle Type Car/Truck/SUV Motorcycle ATV/Dirt Bike RV/Camper Boat/Watercraft Aircraft Trailer Golf Cart Farm Vehicle Industrial Vehicle Other Year: Make: Model: VIN: Mileage: Date Last Used (MM/DD/YYYY): Operable (yes/no): Title Present (yes/no): Vehicle Condition (good/fair/poor): Vehicle Notes/Requests:

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