National Kidney Foundation of Georgia | Giving Back | Kidney Cars

Giving Back > Kidney Cars > Donation Form

To donate your car online, please read all instructions carefully, complete all required fields, and click "Submit." We accept vehicles from all area codes in Georgia!! Thank you for your support!

* required fields

* Name
* Home Phone
Work Phone
Cell Phone
* Home Address
* City
* Zip Code
* E-mail

Please send me an information package only .

Complete information below only if you are donating your car.

1. How did you hear about this program?

2. Where is the vehicle located? (if different from address listed above):

* 3. What kind of vehicle are you donating?
* Year: *Make: * Model:

* 4. Is the car currently drivable?

* 5. Are all tires inflated?

6. When was the last time the vehicle was driven?

* 7. Does the vehicle have any structural damage?
If so, please describe:

* 8. Is there anything wrong with the transmission?
If so, please describe:

* 9. Is there anything wrong with the engine?
If so, please describe:

Click the "Submit" button only once and do not
use the back button on your browser.

If you have any questions, contact Karen Rivera.

	Special Events
	Volunteer Opportunities

Top

Home | Downloads | Site Map | Contact Us