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Christians Overcoming Cancer P.O. Pox 307133 Gahanna,Ohio 43230 (614) 227-9400 info@christiansovercomingcancer.com www.ChristiansOvercomingCancer.com Christians Overcoming Cancer (COC) is a faith-based, 501(c)(3) non-profit organization passionate about helping cancer patients, both nationally and internationally, SUCCEED on their ROAD TO RECOVERY through Awareness, Emotional Support and Financial Relief. Our services are provided to all cancer patients while in active treatment with respect, compassion, and without religious discrimination. Thank you for choosing to donate your vehicle to our cause! Donate Now! Please note: Fields marked with an * are required * Donor Name: Pick-up location address: City: State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N. Carolina N. Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island S. Carolina S. Dakota Tennessee Texas Utah Vermont Virginia W. Virginia Washington Wisconsin Wyoming Other Zip/Postal: * Telephone Number: Alt. Telephone Number: E-mail Address: * Vehicle Type: Select Vehicle Type Car/Truck/SUV Motorcycle ATV/Dirt Bike RV/Camper Boat/Watercraft Aircraft Trailer Golf Cart Farm Vehicle Industrial Vehicle Other Year: Make: Model: VIN: Mileage: Date Last Used (MM/DD/YYYY): Operable (yes/no): Title Present (yes/no): Vehicle Condition (good/fair/poor): Vehicle Notes/Requests:

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