Car Donation Form

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Food on Wheels
577 East 5th Street
Brooklyn, NY 11218
donate@foodonwheels.org
Phone: 1-877-44-MEALS
Fax: 1-866-576-7258

If you require immediate assistance, please call 1-877-44-MEALS. Otherwise, please fill out the form below.

Name:
Address:
City:
State:
Zip:
Email:
Phone:
	Have you donated a car to yet? Yes No
	How would you rate our service? (with 1 being worst and 10 the best) 1 2 3 4 5 6 7 8 9 10
	Are you planning to donate a vehicle in the future? Yes No
	If so, how long from now?
	What kind of vehicle would you be donating? (check all that apply): Car Truck Van Boat Other
Make of Vehicle
Model of Vehicle
Year of Vehicle
Additional Questions or Comments