LifeLong Medical Care

Contact Information

Berkeley

California

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LifeLong Medical Care provides high-quality health and social services to underserved people of all ages; creates models of care for the elderly, people with disabilities and families; and advocates for continuous improvements in the health of our communities.

Donate a Car to Charity

Please fill out the form below to donate a car!

Name*
Prefix First Middle Last Suffix
Email*

Phone*
Work Phone
Cell Phone
Address*
Street Address City State ZIP Code

Business Name
Business Phone
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Color*
Numer of Doors
Current Mileage*
Registration*

Yes

No
State Vehicle Registered
State

Registration Expiration Date*
MM slash DD slash YYYY

Why don't you have the Registratrion?
Do You Have the Certificate of Title (Pink Slip)?*

Yes

No
Is the Vehicle in Running Condition?*
Why don't you have the Pink Slip?
Why isn't the Vehicle in Running Condition?
Vehicle Identification Number*
License Plate Number
Describe Mechanical Issues, if any
Describe Condition of Body
Describe Condition of Paint
Describe Condition of Interior
To Which Charity Would You Like to Donate Your Vehicle?*
Is the Vehicle Located at the Address Above?*

Yes

No
How did you hear about our car donation program?*
Notate the address where the vehicle is located
Street Address City State ZIP Code

Comments
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