Tax Deductible Vehicle Donation Program Application
Please submit one vehicle at a time for consideration in the tax deductible vehicle donation program at Virginia Clean Cities. If you would like to submit multiple vehicles, please contact Virginia Clean Cities at (540) 568-4051.

We will use this information to contact you during the donation process and to complete your tax receipt. DO NOT SCRAP OR DISABLE THE VEHICLE UNTIL APPLICATION IS APPROVED.

If your vehicle is not at this address or we should contact someone else to arrange a vehicle pickup, please use the optional sections below.
Vehicle Identification Number (VIN) *
Vehicle Year *
Vehicle Model *
Vehicle Make *
Mileage *
Employer Identification # or Social Security # *
Owner or Company Name *
Address *
Phone Number *
Email Address *
Use my contact information when scheduling vehicle pickup *
Contact information for vehicle pickup
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