MERS Goodwill

Name:

Address:

City/State/Zip Code:

Home Phone:

Work Phone:

Cell Phone:

Email: *

Year/ Make/ Model/ Color

Vehicle Milage/ VIN #/ Title #

Please upload the front of the car's title

(PDF, jpeg)

Please upload the back of the car's title

(PDF, jpeg)

Attach donor information sheet

(PDF, jpeg)

Does the vehicle run?

Yes

Please list any known problems: (i.e. dead battery, bad transmission, bad starter...)

Pick up address if different from location above:

How did you hear about this program? *

Please add any further comments or questions here:

TAX PAYER ID number will be required if claiming a deduction over $500. If required we will contact you.

Thank you for donating your vehicle to MERS/Goodwill!

1727 Locust Street, Saint Louis, MO 63103