Community Living Ajax Pickering Whitby

It is the mission of the Association to promote social inclusion for individuals with a developmental disability and provide a wide range of options including; residential supports, Vocational Supports, Community Access Supports, Specialized Services, Support Families. All individuals should be provided with a wide range of options to meet their full potential: residential, employment, recreational, social, health and education.

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 *
	Please select... ---- Canada ---- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---- USA ---- 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
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 Community Living Ajax Pickering Whitby.
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) Address* ZIP/Postal Code * City * State/Province * Please select... ---- Canada ---- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---- USA ---- 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Condition of vehicle	Comments about vehicle
Please choose one. Working Not Working
Are there any liens/loans outstanding on the vehicle. Select Yes No *
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=