 
  
  		Donate a Car to
  		
  		  		
  		Leukemia & Lymphoma Society of Canada
  	
 
 	
 	 	 
 	 	
 | Donor's Information Tax receipt will be issued to the name listed in this section Name must match the vehicle registration | |
|---|---|
| First Name (or Company Name) | |
| Last Name | |
| Street Address | |
| City or Town | |
| Province | |
| Postal Code | |
| Phone | |
| Phone Other | |
| Email Address | |
| Confirm Email Address | |
| Vehicle Information | |||
|---|---|---|---|
| Year (4 digits) | |||
| Make | |||
| Model | |||
| Color | |||
| Serial Number (17 characters) | |||
| Odometer | |||
| 
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| Please Select One: | |||
| 
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| 
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| What chapter would you like to donate your vehicle to? |