Charity / Organization *

Contact Name *

Contact Person's Title

Address *

Province / State Please select... Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---------- Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming ---------- Other

Postal / Zip Code *

Suite / Apt

City *

Country Canada United States

Phone *

Extension

Email *

Charity Tax Number

Website Address

Info About Charity
(Less than 90 words please)

Name of Recycler / Affiliate that you already have a relationship with. (1 only please, otherwise you will be associated with the head office and pick ups will be dispatched from there.)

Just a few of the reasons to join: Joining is easy as 1-2-3! Send in this Registration form. Receive more donations and be part of the environmental solution! Designed and run by Certified Auto Recyclers who will recycle the vehicle in an eco-friendly manner! Let us Drive those Donations to Your Organization!

By completing this form:

I am applying for representation of my Charity on the CharityCar.ca/CharityCar.us and GreenVehicleDisposal.com site. I do have the legal right to sign my Charity / Organization up for this type of program.

Moreover, I agree to:

Post a Vehicle Donation page and link to the customized form GreenVehicleDisposal.com has built for me so that more donors can see the opportunity to donate their high-polluting older vehicles and recycle them in an environmentally friendly manner.

If we are a Charity that issue Tax Receipts we will process the donations we get and send the tax receipts to the donors from the CharityCar.ca/CharityCar.us and GreenVehicleDisposal.com websites.