I am a[n] Business Charity Individual Other

You must select a donor type.

First Name

The first name must be at most 30 characters long.

Initial

The initial must be at most 1 character long.

Last Name

You must enter a last name.

The last name must be at most 65 characters long.

Address Line One

You must enter address line one.

The address line one must be at most 57 character long.

Address Line Two

The address line two must be at most 57 character long.

Home Phone

You must enter a phone number.

The phone number must be in the format 999-999-9999

Work Phone

The phone number must be in the format 999-999-9999

Cell Phone

The phone number must be in the format 999-999-9999

Email Address

You must enter an email address.

The email address must be in the correct format

The email address must be at most 100 characters long.

I wish to recieve the newsletter via email(You can easily unsubscribe at any time) I wish to receive the newsletter via mail

Year Make Model Colour

VIN Odometer Mileage Type Kilometers Miles

Does the vehicle have a current safety? Yes No

You must select a current safety option.

Is the vehicle driveable? No Not sure Yes Yes, but not insured

You must select a driveable option.

Do the tires hold air? Missing tires No Not sure Yes

You must select a tires hold air answer.

Does the vehicle have keys? Yes No

You must select a current safety option.

Pickup Address

You must enter a pickup address

Pickup City

You must enter a pickup city

The pickup city must be at most 30 characters long.

Pickup Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

You must select a pickup province.

How should we pick up the vehicle? Car Hauler (drive) Drive (ATC will send a driver with a dealer plate) Drop Off (you are planning to deliver the vehicle to ATC) Other (please explain under Special Instructions) Tow (ATC will make towing arrangements) Tow - Alex (Tow) Tow - Cornie (Tow) Tow - Tartan (Tow - Tartan) Winkler (pick up)

You must select a pickup type.

Which city are you closest to? Brandon Dryden Flin Flon Pembina Valley Steinbach Thunder Bay Winnipeg

You must select a region.

Rural or Local? Local (Inside the city limits of Brandon, Winnipeg or Thunder Bay) Rural (Outside the city limits of Brandon, Winnipeg or Thunder Bay)

You must select a pickup area.

How would you like to receive the release form? Driver (Local pickups only) Email Mail Other (Please explain under Special Instructions)

You must select a release form method method.

How would you like to receive your tax receipt? Email Mail

You must select a tax receipt method.

How did you hear about us? Church Flyer Internet Previous Donor Radio TV Word of Mouth Billboard Newspaper Other Source Thrift Store

You must select an advertising method.

Special Instructions Additional Notes