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MEMBERSHIP
MCC ANSAR
Vehicle Donation
Step
1
of
3
- DONOR INFORMATION
33%
Your Name (as you would like it to appear on the tax receipt) *
(Required)
Spouse’s Name (only if you wish to include your spouse on tax receipt)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Email
(Required)
Phone
(Required)
Year
(Required)
Make and Model
(Required)
Has your vehicle passed smog in the last 60 days?
(Required)
Yes
No
If not, when was the last smog check performed?
Transmission
(Required)
Odometer
(Required)
How does the vehicle run and drive?
(Required)
Is the Check Engine light on?
(Required)
Yes
No
If yes, why is the light on?
Have any major repairs been performed in the past calendar year?
(Required)
Do you feel your vehicle currently needs any major repairs?
(Required)
Do you feel your vehicle currently needs any preventative repairs?
(Required)
Can you perform a smog before MCC takes possession of your vehicle?
(Required)
Once approved for donation by the Car Program Team, how would you prefer MCC take possession of your vehicle?
(Required)
I can drive the vehicle to MCC in Pleasanton (or to MCC's volunteer repair shop in Concord, if we feel repairs or maintenance is necessary before you vehicle can be donated)?
I would prefer a MCC Vehicle Program volunteer come to my home and drive the vehicle to MCC in Pleasanton or repair shop in Concord.
Do you have the title?
(Required)
Yes
No
If not, please explain:
(Required)
Until what month and year is the registration on the vehicle valid?
(Required)
Do you currently have insurance on the vehicle?
(Required)
Yes
No
If not, please explain:
MCC’s charity administration team determines who receives your vehicle based on a weighted rubric. Our waiting list includes domestic violence victims, single moms, struggling Bay Area families, and newly-arrived refugee families. We work with a host of masjids and non-profits in the Bay Area to execute this unique program. At donor’s discretion, we factor in preference. Please list if you have a preference about the type of family who you would like your vehicle gifted to. We will try to honor your request but will prioritize based on the most in need from amongst our waiting list. (optional)
Any other comments or special instructions?
Signature
(Required)
CAPTCHA
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