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First Name*

Last Name


City, State, Zip*

Contact Number*

Email Address*

Recycle Information Form

What Would Like To Recycle?*
 Truck Car Boat Scrap Metal Other

Please Let Us Know if You Want to Receive Cash or Donate Your Vehicle?*
 Yes, I want To Donate My Vehicle No, I want To Recycle My Vehicle For Cash

Vehicle Year

VIN Number


Licence Plate Number


Condition Of Vehicle?*
 Vehicle Is Working Vehicle Is Not Working

There are Liens (or) Loans On Vehicle*
 Yes No

Do You Have The Title of The Vehicle?*
 Yes No

Does Vehicle Have (4) Working Tires?*
 Yes No

Will Vehicle Have To Be Put On A Flatbed Tow Truck?*
 Yes No