Wisconsin and Ozaukee Humane Societies: Survey

Car Donation Form

Are you thinking about trading in your car,
boat or RV? Why not donate it instead? The
Wisconsin Humane Society has a vehicle donation
program
that allows you to receive a tax deduction and
help animals at the same time. WHS will sell
the vehicle and use the proceeds to help
animals. Vehicle donations to WHS are 100% tax
deductible.
To donate your vehicle, simply fill out the following form and you will be contacted shortly after!

1.

Please fill out the donor information below:

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	StateRequired	ZIPRequired

*

Country: Required

Phone Number:

Remember me.

*2.

Is the vehicle located at the address above? If not, please fill in vehicle location below.

*3.

List the address where the vehicle is located.

(Maximum response 255 chars, approx. 5 rows of text)

*4.

What year is the vehicle?

*5.

What is the make of the vehicle?

6.

What is the model of the vehicle?

*7.

What is the VIN # (Vehicle Identification Number) of the vehicle?

8.

What is the license plate #, if applicable?

*9.

Please check all that apply:

	2-Door
	4-Door
	Station-Wagon
	4 Wheel Drive

*10.

Does the vehicle run and drive as it?

11.

Explain if needed?

*12.

Do you have the title?

13.

If not, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

14.

Please note any problems or damage (engine problems, transmission, tires, body, other):

(Maximum response 255 chars, approx. 5 rows of text)

15.

Please list any special instructions:

(Maximum response 255 chars, approx. 5 rows of text)