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Vehicle Donation Form
Vehicle Information
Vehicle Type:
Car
SUV
Minivan
Pickup Truck
Full-Size Van
Commercial Truck
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Colour:
VIN Number:
Truck Cab Type:
Regular Cab
Extended Cab
Crew Cab
Truck Box Type:
Short Box
Regular Box
Long Box
Drivetrain:
2-Wheel Drive
4-Wheel Drive
Tranmission:
Automatic
Standard
# of Doors:
2-Door
4-Door
Exact Odometer Reading:
km
mi
When was it last driven?
Is the vehicle driveable?
Yes
No
Will the vehicle start?
Yes
No
Vehicle Condition
Engine Condition:
Poor
Fair
Good
Excellent
Engine Comments:
Brakes Condition:
Poor
Fair
Good
Excellent
Brakes Comments:
Tires Condition:
Poor
Fair
Good
Excellent
Tires Inflated?
Yes
No
Tires Comments:
Tires Hold Air?
Yes
No
Steering Condition:
Poor
Fair
Good
Excellent
Steering Comments:
Transmission Cond.:
Poor
Fair
Good
Excellent
Transmission Comm.:
Vehicle Condition (continued)
Rust on Vehicle:
None
Minor
Intermediate
Major
Where is the rust?
Body Damage:
None
Minor
Intermediate
Major
Where is the damage?
Other Comments on Vehicle Condition:
Are you the registered owner of the vehicle?
Yes
No
YOUR CONTACT INFORMATION
(exactly as per vehicle ownership)
First Name:
Last Name:
Organization Name:
(business donors only)
Email Address:
Phone:
Address:
City, Prov:
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Postal Code:
VEHICLE OWNER INFORMATION
(exactly as per vehicle ownership)
First Name:
Last Name:
Org. Name:
(business donors only)
Address:
City, Prov:
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Postal Code:
Delivery Information
How would you like the vehicle delivered to Teen Challenge?
I will deliver it to Teen Challenge.
Please pick it up at my address.
Please pick it up at the owner's address.
Please pick it up at another address.
Address:
City, Prov:
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Postal Code:
Contact Name:
Contact Phone:
How did you hear about Teen Challenge Vehicle Donations:
Mailing
Internet
Dealership
Word of Mouth
Auto/Truck Trader
TV - Global
TV - A-Channel
Radio Station
Other
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Vehicles
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Home
Staff Portal Login
Locations
Locations Map
Ways to Help
Sponsor a Student
Give Today
Donate Your Used Vehicle
Book a Presentation
Participate in an Event
Get Help
Program Basics
Apply to the Program
Info for Parents
Drugs: Fast Facts
Links / Resources
About Us
Welcome from the National Director
History / Mission / Values
Endorsements
Teen Challenge Choir
Media Room
Contact Us
Contact Form
Employment Opportunities
Locations in Canada
Privacy Policy
Subscribe
Email Testimonies
Teen Challenge Canada
HOME OFFICE
(888) 417-7777
webadmin@teenchallenge.ca