Kokua in Kind, LLC

Vehicle Donation Form

Please fill out this form as completely as possible. Upon submitting this form we will contact you within one (1) business day via telephone.

Name:
Street Address:
City:
State:
Zip Code:
Phone(s):
Email:

Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Color:
License Plate:
VIN:
Mileage:
Charity to Benefit:

I Have the Vehicle Title:	Yes No
if no please explain:
My Vehicle is Drivable:	Yes No
if no please explain:
Damage to Exterior:	Yes No
if yes please describe:
Damage to Interior:	Yes No
if yes please describe:

If you have any difficulties with this form or wish to speak to a customer service representative, please call us at (808) 834-6603 Monday - Friday 10AM - 6PM.

Privacy Policy: Your privacy is very important to us. Under no circumstances will information submitted on your car donation form be made available to outside parties. This information will only be used for the purpose of completing your vehicle donation.