How to apply for a donated vehicle.

Referral Organization Information

The information in this section must be completed by the organization or agency that is referring their client as a potential recipient to apply to receive a donated vehicle.

The referral organization must be on our list of recognized referral organizations for the clients application to be accepted. All other applications will be rejected by the program.

Please fill out all of the fields and contact information. The staff referring the client will be contacted before the application is accepted by the program.

Applicant Information

This section is for the applicant applying for to be considered to receive a donated vehicle to complete.

The applicant must complete the application and answer the information truthfully. After the application is verified the applicant will go on a waiting list.

There is no timeline related to receive a donated vehicle and the program will contact the referral organization when the client is next on the list. Applicants should not contact the program.

Contact Information

Anthony E. Conway

(660) 238-0725

tconway61555@gmail.com

Referral Organization Information

Select a date

Referral Organization/Agency

Referral/Staff Person Name

Staff Contact Number

Email Address

Applicant Information

Recipient Name

Address

Phone Number

Marital Status

Single (Never Married)

Divorced

Separated

Widowed

Birthday

Do you have children living with you? How many and what are their ages?

Driving and Criminal Background Records

Driver's License Number

State Issued

Expriation Date

If yes, why?

Number of traffic violations in the past two years:

Number of traffic accidents in the past two years:

If yes, when?

Employment Information

Employer

Work Phone Number

Supervisor

Salary

Write a short statement describing why you need a vehicle.

Any applicant not meeting the program's criteria, or who fails to provide the required documentation, or provides false information will be disqualified. Fill out the application to the best of your ability.

Signing this, the recipient agrees that the vehicle donated to the recipient at $0.00 is the sole responsibility of the recipient. All vehicles are donated AS-IS and come with no warranties or guarantees. The recipient agrees to hold Cars 4 Missouri and its employees free from all harm and/or liability. Failing to sign this application will result in disqualification.

Recipient Signiture

Thanks for submitting!