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DEBRA of Canada

DEBRA of Canada, Stoney Creek,ON Vehicle Donation Quotation Form
 

Epidermolysis Bullosa, known as EB, is the name of a rare group of genetic skin disorders causing blistering and shearing of the skin from even the gentlest friction and sometimes spontaneously.There are three major types of EB; Simplex, Dystrophic and Junctional. These vary from relatively mild to incapacitating, crippling, and sometimes fatal disorders. Within these there are over twenty different sub types of EB, each with their own characteristic symptoms. Our goal at DEBRA Canada is to heighten awareness of EB and to be a source of support and comfort for EB families

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 DEBRA of Canada.

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=