Let’s work together to help those in our community

Fill out some info and we will be in touch shortly! Once the form is submitted our Car Donantion Committee will meet (once a month) to go over new applications.

Organization Information

First Name

Last Name

Name of Organization

Primary Goal of Your Organization

Phone

(###)

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Any More Needed Information

Name of Client (Referral)

First Name

Last Name

How would you like the communication?

Phone

(###)

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Address

Put N/A if Homeless

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long have you been working with the Client?

Why do you believe your client needs a Car?

Tell Us About the Clients Journey With You.

How will your client fund maintenance for the vehicle?(Personal budget, grants from an organization, family)

We do our best to refurbish our cars to be in the best working condition without exceeding the vehicles value, because of this the vehicle may have other ongoing concerns such as oil leaks, exhaust leaks ect. All vehicles go through a safety inspection. Any parts regarding the safety of the vehicle are replaced.

Are there any other services we could assist your client in?

Housing Assistance

Job Placement

Financial Coaching

Life Coaching