Car Donation Process

1. You fill out the information on the form below and click "Submit". Please make sure to fill in all fields.

2. A representative from the Kidney Foundation will call you to give you your reference number and get your social security number. Social Security numbers are necessary to complete the process and are used only for tax purposes.

3. You call ADESA with the reference number to arrange for free towing of the vehicle.

4. Once the vehicle has been auctioned, you will receive a letter with the information for your taxes.

Car Donation Information Form

Please enter the following information - All information at the top is required.

Name:

Address:
City: State (abbr): Zip:

Home Phone: Other Phone:

E-mail Address:

Name car is titled in:

Year: Make:
Model:

2dr 4dr

The following information is used for survey purposes only.

How did you hear about the car donation program?

Print publication - which one?
Radio Station - which one?
TV - which station, program?
Billboard - location?
Internet - website
Word of mouth
Gave before
Other

Age group		Gender		County of Residence