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ALS Society of Nova Scotia

ALS Society of Nova Scotia, Halifax ,NS Vehicle Donation Quotation Form
 

The ALS Society of Nova Scotia is dedicated to helping individuals with ALS who reside in Nova Scotia with information, help navigating the health care system, family support and our Equipment Loan Program. The ALS Society of Nova Scotia Equipment Loan Program is designed to help people cope with the daily challenges of decreasing mobility and independence, through obtaining basic and essential assistive equipment. This includes mobility equipment, communication devices and respiratory equipment, as needed. The equipment loan program is available to clients who are unable to obtain equipment through other funding sources.

Vehicle Donation Quotation Form

Please note: By filling out the form below you are not committed to donating your car. Filling out this form will allow us to contact you with a quote on the price the charity of your choice will receive for your vehicle. All personal data is kept strictly private and will never be sold.
 
Owner Information Section
Name * State/Province *
Address on Ownership * ZIP/Postal Code *
City *
Daytime Phone Number * Phone/Cell/Work Number *
Email *

Donating Your vehicle?

Yes, I want to donate my vehicle to ALS Society of Nova Scotia.

Vehicle Information Section

Year * Make *
Model * Mileage
License Plate VIN #
 If your vehicle is located at a different address from your home address, please check the box and then complete the following section, if same as home address (skip)
Condition of vehicle Comments about vehicle
*
I do have the ownership / title to transfer to the Authorized Treatment Facility.

Vehicle Images Section
Uploading images will help us to better determine the value of your vehicle, possibly increasing what we will pay for your car.

Human? Answer this question 4+7=