Donate

Three Easy Ways to Donate:

1. Complete form below and submit online (* is required)
2. Print and mail to:
   Wheels for Meals Vehicle Donation Program
   139 Mill Rock Road East
   Suite 102
   Old Saybrook, CT 06475

Complete the form below.

Charity Name* Please Select ... Ahava Kids American Lung Association of Connecticut American Lung Association of Delaware American Lung Association of Georgia American Lung Association of Maine American Lung Association of New Hampshire American Lung Association of New Jersey American Lung Association of New York City American Lung Association of New York State American Lung Association of Pennsylvania American Lung Association of Rhode Island American Lung Association of South Carolina American Lung Association of Vermont American Lung Association of West Virginia American Red Cross of CT - Ansonia American Red Cross of CT - Bridgeport American Red Cross of CT - Danbury American Red Cross of CT - Darien American Red Cross of CT - Farmington American Red Cross of CT - Greenwich American Red Cross of CT - Middletown American Red Cross of CT - Milford American Red Cross of CT - New Canaan American Red Cross of CT - New Haven American Red Cross of CT - Stamford American Red Cross of CT - Waterbury American Red Cross of FL - Bradenton American Red Cross of FL - Miami American Red Cross of FL - Port Charlotte American Red Cross of FL - Tampa American Red Cross of GA - Athens American Red Cross of GA - Atlanta American Red Cross of NY - White Plains American Red Cross of OH - Cincinnati American Red Cross of OK - Altus American Red Cross of OK - Ardmore American Red Cross of OK - Blackwell American Red Cross of OK - El Reno American Red Cross of OK - Elk City American Red Cross of OK - Norman American Red Cross of OK - Oklahoma City American Red Cross of OK - Stillwater American Red Cross of PA - Bethlehem American Red Cross of PA - Bloomburg American Red Cross of PA - Carlise American Red Cross of PA - Chamsberburg American Red Cross of PA - Honesdale American Red Cross of PA - Lancaster American Red Cross of PA - Lewisburg American Red Cross of PA - Middleburg American Red Cross of PA - Milton American Red Cross of PA - Pottsville American Red Cross of PA - Scranton American Red Cross of PA - Wiles-Barre American Red Cross of PA - Williamsport American Red Cross of PA - York American Red Cross of TN - Memphis American Red Cross of TN - Murfeesboro American Red Cross of WA - Kennewick American Red Cross of WA - Okanogan American Red Cross of WA - Walla Walla Ann’s Place Autism Connecticut Breast Cancer Foundation Children’s Home Connecticut Public Television Estuary Council of Seniors National Scleroderma Foundation New Hampshire Public Television Peaceful Paws United Pentecostal Churches Western Community Partners WLIU WNPR

Name* Mr. Mrs. Ms. Street*

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 Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip*

Best/Day time Phone* Cell Email

Vehicle Make* Model* Year*

Color* Mileage*

Vehicle ID # (VIN)*

Location of vehicle if different from above

Is the title free and clear of lien? Yes No

Can vehicle be driven 20 miles? Yes No If car cannot be driven 20 miles, state the reason:

Vehicle must be accessible by flatbed tow truck (i.e. driveway)?

Check off areas of damage Right Front Left Front Hood Right Rear Left Rear Trunk Right Side Left Side Roof

Note: The vehicle MUST have a title, no liens, and four inflated tires and have a complete engine to be accepted into our program. Please remove license plates and all personal items from vehicle before scheduled pick-up date and place the title and keys in the glove box. Donor signs name on seller location on back of title and charity name is listed as buyer.

How did you hear about our program?

Radio Please specify: Friend/Relative Please specify: Mailing Kind: Newspaper Which one? Emissions Station Please specify: Billboard Location? 2nd Time Donor Please specify: Other Please specify:

Comments:  (Enter case-sensitive code displayed tothe left)   Thank You For Your Donation For more information please contact us today.