Online Utah Motorhome Donation Form

Note: All fields are required ---Do not print this form--- For a printable form, hit the back arrow and select the "Printable Donation Form" button

Your Contact Information

Title:

First Name:

Last Name:

Company Name (Optional):

Mailing Address for receipt (vehicle location address to be entered below):

City:

State:

Zip:

Day Phone: Format: 000 000-0000
Area Code: Number:

Cell or alternate phone number

Cell Area Code: Number:

Email:

Verify Email:

Please Note: this email address will be used to email you your official
tax receipt, and for all correspondence with the Kidney Foundation.
Your email address will not be shared or sold.

Contact person (if different from owner):

Contact Phone: Area Code: Number:

Vehicle Identification Information

Year:

Make:

Model:

Color:

Mileage:

Vehicle Length (in feet):

Engine Type: DieselGasoline

Is the motorhome roadworthy?: Yes No

Vehicle Title Information

State of title:

Title Number:

VIN:

Note: If you do not have a clear title, please call our
office 9-5 M-F at 1-800-869-5277. We can help you
apply for a replacement title (Utah titles only).

Condition of Vehicle

When was the motorhome last driven?

Do you have the keys? YesNo

Does the vehicle have four inflated tires? YesNo

General Interior Condition: Excellent Good Fair Poor

General Exterior Condition: Excellent Good Fair Poor

Overall Vehicle Condition: Excellent Good Fair Poor

Does your motorhome have any water or roof damage? Yes No

If yes, please describe.

Do the kitchen appliances, bathroom utilities (toilet, shower, sink, etc.), and generators all work? Yes No

If no, please describe.

Does your vehicle have any body damage? Yes No

If yes, please describe.

Comments / Additional Instructions

How did you hear about us?

Please tell us how you learned of us.

How else did you hear about us? (Optional)

Online Motorhome Donation