Uhcan Ohio Vehicle/Vessel Donation Information

If you have any questions you would like answered previous to initiating the donation process, please feel free to email or call us at 614-456-0060.

Donor Information:

First Name _____________________________________________________________

Last Name______________________________________________________________

Address________________________________________________________________

City ___________________________________________________________________

State Zip _______________________________________________________________

Daytime Phone  __________________________________________________________ 

Alternate Phone __________________________________________________________

E-Mail _________________________________________________________________

Vehicle Location: 

Is vehicle location is same as Donor address above. Yes___ No___

Address _________________________________________________________________

City ____________________________________________________________________

State & Zip ______________________________________________________________


Vehicle Information: 

Year ___________________________________________________________________

Make __________________________________________________________________

Model  _________________________________________________________________

License Plate  ____________________________________________________________

VIN  __________________________________________________________________

Damage to Body (Describe):  ________________________________________________
_______________________________________________________________________

Damage to Interior (Describe): _______________________________________________
_______________________________________________________________________

Is your vehicle drivable as is? If not, please explain. ________________________________
_______________________________________________________________________
_______________________________________________________________________
Do you have the Certificate of Title? If not, please explain.  __________________________
_______________________________________________________________________
_______________________________________________________________________
 

Special Instructions or Other Comments:  ________________________________________

________________________________________________________________________

If you have any questions you would like answered prior to initiating the donation process, please feel free to email or call us toll-free at 614-456-0060.

Print information and fax to 614-456-0059 or mail to:

Uhcan Ohio

404 S. Third St.

Columbus, Ohio 43215