The Peninsula Stroke Association (PSA) is a not-for-profit organization serving the
people of Santa Clara and San Mateo counties in Northern California.
PSA's mission is to reduce the incidence of stroke through education
and to help alleviate stroke's devastating aftermath through
programs to support survivors and caregivers.

Online Vehicle Donation Form

You will receive a call from one of our representatives within 24 hours of submitting this online form. Should you have any questions regarding the vehicle donation process, please feel free to contact us at 800-574-0888 Tuesday to Saturday from 9am to 5pm.

Contact

* First Name:

* Last Name:

* Phone:

ex: 123-456-7890

Work:

ex: 123-456-7890

E-mail:

* Address:

* City:

* State:

* Zip:

Location of Vehicle

If different from above address

Address:

City:

State:

Zip:

Vehicle Info

Year:

Make:

Model:

VIN#:

License:

Is the vehicle currently registered?

click for yes

Title available?

click for yes

Is vehicle in running condition?

click for yes

Vehicle Mileage:

Condition of Exterior of Vehicle or body damage to vehicle:

Condition of Interior of Vehicle:

Describe any mechanical problems:

Comments / Other Information: