{"id":2446,"date":"2025-08-21T08:47:25","date_gmt":"2025-08-21T08:47:25","guid":{"rendered":"https:\/\/www.wilberts.com\/u-pull-it\/?page_id=2446"},"modified":"2025-08-21T08:52:48","modified_gmt":"2025-08-21T08:52:48","slug":"vehicle-donation-form","status":"publish","type":"page","link":"https:\/\/www.wilberts.com\/u-pull-it\/vehicle-donation\/vehicle-donation-form\/","title":{"rendered":"Vehicle Donation Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2446\" class=\"elementor elementor-2446\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-66690d1 e-flex e-con-boxed e-con e-parent\" data-id=\"66690d1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-627827c e-con-full e-flex e-con e-child\" data-id=\"627827c\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2621837 elementor-widget elementor-widget-heading\" data-id=\"2621837\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Vehicle Donation Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ada2976 elementor-widget elementor-widget-shortcode\" data-id=\"ada2976\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script id=\"confirmation-template\" type=\"text\/x-handlebars-template\">\n    <h3>Thank You!<\/h3>\r\nYour message has been sent successfully. We will get back to you soon.<\/script>\n<div class=\"wilberts-form-container\">\n    <form id=\"form_vehicle_donation\" class=\"form\" novalidate>\n        <input type=\"hidden\" id=\"form_nonce\" name=\"form_nonce\" value=\"ee90e4ee33\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/u-pull-it\/wp-json\/wp\/v2\/pages\/2446\" \/>        <span class=\"required-desc\"><span class=\"required-indicator\">*<\/span> indicates a required field<\/span>\n        <div class=\"content-section\">\n\n            <div class=\"\">\n                <div class=\"row\">\n                    <div class=\"col-12\">\n                        <p>Please note that your information is saved on our server as you enter it.<\/p>\n                        <h2 class=\"mt-3 mb-0\">Charity Information<\/h2>\n                    <\/div>\n                <\/div>\n\n                <div class=\"row\">\n                    <div class=\"col-sm-12\">\n                        <label required>Charity<\/label>\n                        <select id=\"charity\" name=\"charity\" data-display-name=\"charity\" required>\n                            <option value=\"\" selected>Select One<\/option>\n                            <option value=\"Open Door Mission\" >Open Door Mission<\/option>\n                            <option value=\"Big Brothers Big Sisters of Greater Rochester\" >Big Brothers Big\n                                Sisters of Greater Rochester<\/option>\n                            <option value=\"Children Awaiting Parents\" >Children Awaiting Parents<\/option>\n                            <option value=\"Flower City Habitat for Humanity\" >Flower City Habitat for Humanity<\/option>\n                            <option value=\"ABVI\" >ABVI<\/option>\n                            <option value=\"Goodwill\" >Goodwill\n                            <\/option>\n                            <option value=\"YWCA\" >YWCA<\/option>\n                            <option value=\"Al Sigl Community of Agencies\" >Al Sigl Community of Agencies<\/option>\n                        <\/select>\n                    <\/div>\n                <\/div>\n            <\/div>\n\n\n            <div class=\"row\">\n                <div class=\"col-12\">\n                    <h2 class=\"mt-3 mb-0\">Vehicle Information<\/h2>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-md-4 col-sm-12\">\n                    <label required>Year<\/label>\n                    <input type=\"number\" id=\"year\" name=\"year\" data-display-name=\"Year\" maxlength=\"4\"\n                        data-regex=\"^[0-9]{4}$\" required \/>\n                <\/div>\n                <div class=\"col-md-4 col-sm-12\">\n                    <label required>Make<\/label>\n                    <input type=\"text\" id=\"make\" name=\"make\" data-display-name=\"Make\" maxlength=\"100\" required \/>\n                <\/div>\n                <div class=\"col-md-4 col-sm-12\">\n                    <label required>Model<\/label>\n                    <input type=\"text\" id=\"model\" name=\"model\" data-display-name=\"Model\" maxlength=\"100\" required \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-sm-12\">\n                    <label>Type<\/label>\n                    <select id=\"vehicleType\" name=\"vehicleType\" data-display-name=\"Type\">\n                        <option value=\"\" selected>Select One<\/option>\n                        <option value=\"Car\">Car<\/option>\n                        <option value=\"Motorcycle\">Motorcycle<\/option>\n                        <option value=\"Other\">Other<\/option>\n                    <\/select>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-12\">\n                    <label>Vehicle Identification Number (VIN)<\/label>\n                    <input type=\"text\" id=\"vin\" name=\"vin\" data-display-name=\"VIN\" maxlength=\"17\" data-regex=\"^[A-Za-z0-9]{17}$\" \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-12\">\n                    <h2 class=\"mt-3 mb-0\">Certification of Title<\/h2>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-md-6 col-sm-12\">\n                    <label>State Issued<\/label>\n                    <select id=\"stateIssued\" name=\"stateIssued\" data-display-name=\"State Issued\">\n                        <option value=\"\" selected=\"selected\">Select a State<\/option>\n                        <option value=\"AL\">Alabama<\/option>\n                        <option value=\"AK\">Alaska<\/option>\n                        <option value=\"AZ\">Arizona<\/option>\n                        <option value=\"AR\">Arkansas<\/option>\n                        <option value=\"CA\">California<\/option>\n                        <option value=\"CO\">Colorado<\/option>\n                        <option value=\"CT\">Connecticut<\/option>\n                        <option value=\"DE\">Delaware<\/option>\n                        <option value=\"DC\">District Of Columbia<\/option>\n                        <option value=\"FL\">Florida<\/option>\n                        <option value=\"GA\">Georgia<\/option>\n                        <option value=\"HI\">Hawaii<\/option>\n                        <option value=\"ID\">Idaho<\/option>\n                        <option value=\"IL\">Illinois<\/option>\n                        <option value=\"IN\">Indiana<\/option>\n                        <option value=\"IA\">Iowa<\/option>\n                        <option value=\"KS\">Kansas<\/option>\n                        <option value=\"KY\">Kentucky<\/option>\n                        <option value=\"LA\">Louisiana<\/option>\n                        <option value=\"ME\">Maine<\/option>\n                        <option value=\"MD\">Maryland<\/option>\n                        <option value=\"MA\">Massachusetts<\/option>\n                        <option value=\"MI\">Michigan<\/option>\n                        <option value=\"MN\">Minnesota<\/option>\n                        <option value=\"MS\">Mississippi<\/option>\n                        <option value=\"MO\">Missouri<\/option>\n                        <option value=\"MT\">Montana<\/option>\n                        <option value=\"NE\">Nebraska<\/option>\n                        <option value=\"NV\">Nevada<\/option>\n                        <option value=\"NH\">New Hampshire<\/option>\n                        <option value=\"NJ\">New Jersey<\/option>\n                        <option value=\"NM\">New Mexico<\/option>\n                        <option value=\"NY\">New York<\/option>\n                        <option value=\"NC\">North Carolina<\/option>\n                        <option value=\"ND\">North Dakota<\/option>\n                        <option value=\"OH\">Ohio<\/option>\n                        <option value=\"OK\">Oklahoma<\/option>\n                        <option value=\"OR\">Oregon<\/option>\n                        <option value=\"PA\">Pennsylvania<\/option>\n                        <option value=\"RI\">Rhode Island<\/option>\n                        <option value=\"SC\">South Carolina<\/option>\n                        <option value=\"SD\">South Dakota<\/option>\n                        <option value=\"TN\">Tennessee<\/option>\n                        <option value=\"TX\">Texas<\/option>\n                        <option value=\"UT\">Utah<\/option>\n                        <option value=\"VT\">Vermont<\/option>\n                        <option value=\"VA\">Virginia<\/option>\n                        <option value=\"WA\">Washington<\/option>\n                        <option value=\"WV\">West Virginia<\/option>\n                        <option value=\"WI\">Wisconsin<\/option>\n                        <option value=\"WY\">Wyoming<\/option>\n                    <\/select>\n                <\/div>\n                <div class=\"col-md-6 col-sm-12\">\n                    <label>Title Number<\/label>\n                    <input type=\"text\" id=\"titleNumber\" name=\"titleNumber\" data-display-name=\"Title Number\"\n                        maxlength=\"100\" \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-md-6 col-sm-12\">\n                    <fieldset id=\"paperworkPresent\" name=\"paperworkPresent\" data-display-name=\"Paperwork Present\"\n                        required>\n                        <legend required>Is Title Paperwork Present?<\/legend>\n                        <label><input type=\"radio\" name=\"paperworkPresent\" value=\"1\">Yes<\/label>\n                        <label><input type=\"radio\" name=\"paperworkPresent\" value=\"0\">No<\/label>\n                    <\/fieldset>\n                <\/div>\n                <div class=\"col-md-6 col-sm-12\">\n                    <fieldset id=\"vehicleComplete\" name=\"vehicleComplete\" data-display-name=\"Vehicle Complete\" required>\n                        <legend required>Is Vehicle Complete?<\/legend>\n                        <label><input type=\"radio\" name=\"vehicleComplete\" value=\"1\">Yes<\/label>\n                        <label><input type=\"radio\" name=\"vehicleComplete\" value=\"0\">No<\/label>\n                    <\/fieldset>\n                <\/div>\n            <\/div>\n\n\n\n\n            <div class=\"row\">\n                <div class=\"col-12\">\n                    <h2 class=\"mt-3 mb-0\">Contact Information<\/h2>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-md-6 col-sm-12\">\n                    <label required>First Name<\/label>\n                    <input type=\"text\" id=\"firstName\" name=\"firstName\" data-display-name=\"First Name\" required \/>\n                <\/div>\n                <div class=\"col-md-6 col-sm-12\">\n                    <label required>Last Name<\/label>\n                    <input type=\"text\" id=\"lastName\" name=\"lastName\" data-display-name=\"Last Name\" required \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-sm-12\">\n                    <label required>Address<\/label>\n                    <input type=\"text\" id=\"address\" name=\"address\" data-display-name=\"Address\" required \/>\n                <\/div>\n            <\/div>\n            <div class=\"row\">\n                <div class=\"col-sm-12\">\n                    <label>Address 2<\/label>\n                    <input type=\"text\" id=\"address2\" name=\"address2\" data-display-name=\"Address 2\" \/>\n                <\/div>\n            <\/div>\n            <div class=\"row\">\n                <div class=\"col-md-6 col-sm-12\">\n                    <label required>City<\/label>\n                    <input type=\"text\" id=\"city\" name=\"city\" data-display-name=\"City\" required \/>\n                <\/div>\n                <div class=\"col-md-6 col-sm-12\">\n                    <label required>State<\/label>\n                    <select id=\"state\" name=\"state\" data-display-name=\"State\" required>\n                        <option value=\"\" selected=\"selected\">Select a State<\/option>\n                        <option value=\"AL\">Alabama<\/option>\n                        <option value=\"AK\">Alaska<\/option>\n                        <option value=\"AZ\">Arizona<\/option>\n                        <option value=\"AR\">Arkansas<\/option>\n                        <option value=\"CA\">California<\/option>\n                        <option value=\"CO\">Colorado<\/option>\n                        <option value=\"CT\">Connecticut<\/option>\n                        <option value=\"DE\">Delaware<\/option>\n                        <option value=\"DC\">District Of Columbia<\/option>\n                        <option value=\"FL\">Florida<\/option>\n                        <option value=\"GA\">Georgia<\/option>\n                        <option value=\"HI\">Hawaii<\/option>\n                        <option value=\"ID\">Idaho<\/option>\n                        <option value=\"IL\">Illinois<\/option>\n                        <option value=\"IN\">Indiana<\/option>\n                        <option value=\"IA\">Iowa<\/option>\n                        <option value=\"KS\">Kansas<\/option>\n                        <option value=\"KY\">Kentucky<\/option>\n                        <option value=\"LA\">Louisiana<\/option>\n                        <option value=\"ME\">Maine<\/option>\n                        <option value=\"MD\">Maryland<\/option>\n                        <option value=\"MA\">Massachusetts<\/option>\n                        <option value=\"MI\">Michigan<\/option>\n                        <option value=\"MN\">Minnesota<\/option>\n                        <option value=\"MS\">Mississippi<\/option>\n                        <option value=\"MO\">Missouri<\/option>\n                        <option value=\"MT\">Montana<\/option>\n                        <option value=\"NE\">Nebraska<\/option>\n                        <option value=\"NV\">Nevada<\/option>\n                        <option value=\"NH\">New Hampshire<\/option>\n                        <option value=\"NJ\">New Jersey<\/option>\n                        <option value=\"NM\">New Mexico<\/option>\n                        <option value=\"NY\">New York<\/option>\n                        <option value=\"NC\">North Carolina<\/option>\n                        <option value=\"ND\">North Dakota<\/option>\n                        <option value=\"OH\">Ohio<\/option>\n                        <option value=\"OK\">Oklahoma<\/option>\n                        <option value=\"OR\">Oregon<\/option>\n                        <option value=\"PA\">Pennsylvania<\/option>\n                        <option value=\"RI\">Rhode Island<\/option>\n                        <option value=\"SC\">South Carolina<\/option>\n                        <option value=\"SD\">South Dakota<\/option>\n                        <option value=\"TN\">Tennessee<\/option>\n                        <option value=\"TX\">Texas<\/option>\n                        <option value=\"UT\">Utah<\/option>\n                        <option value=\"VT\">Vermont<\/option>\n                        <option value=\"VA\">Virginia<\/option>\n                        <option value=\"WA\">Washington<\/option>\n                        <option value=\"WV\">West Virginia<\/option>\n                        <option value=\"WI\">Wisconsin<\/option>\n                        <option value=\"WY\">Wyoming<\/option>\n                    <\/select>\n                <\/div>\n            <\/div>\n            <div class=\"row\">\n                <div class=\"col-sm-12\">\n                    <label required>Zip Code<\/label>\n                    <input type=\"text\" id=\"zipCode\" name=\"zipCode\" data-display-name=\"Zip Code\" data-regex=\"^[0-9]{5}$\"\n                        required \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-md-6 col-sm-12\">\n                    <label required>Phone Number<\/label>\n                    <input type=\"text\" id=\"phoneNumber\" name=\"phoneNumber\" class=\"phone\" placeholder=\"(xxx) xxx-xxxx\"\n                        data-display-name=\"Phone Number\" data-type=\"phone\" maxlength=\"14\" required \/>\n                <\/div>\n                <div class=\"col-md-6 col-sm-12\">\n                    <label>Email<\/label>\n                    <input type=\"text\" id=\"email\" name=\"email\" data-display-name=\"Email\" data-type=\"email\"\n                        maxlength=\"100\" \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-sm-6\">\n                    <label required>Legal Owner of Vehicle<\/label>\n                    <input type=\"text\" id=\"owner\" name=\"owner\" data-display-name=\"Legal Owner of Vehicle\" required \/>\n                <\/div>\n            <\/div>\n\n            <div class=\"row\">\n                <div class=\"col-12\">\n                    <label>Vehicle Condition (brief description)<\/label>\n                    <textarea type=\"text\" id=\"vehicleCondition\" name=\"vehicleCondition\"\n                        data-display-name=\"Vehicle Condition\"><\/textarea>\n                <\/div>\n            <\/div>\n\n                            <div class=\"row\">\n                    <div class=\"col-12\">\n                        <div class=\"g-recaptcha\" data-sitekey=\"6LcPrIsrAAAAAAe7z4diq0pxNFKk__Y1wNIDaDQg\"><\/div>\n                    <\/div>\n                <\/div>\n                    <\/div>\n\n        <div class=\"row\">\n            <div class=\"col-12\">\n                <ul class=\"errors\"><\/ul>\n                <button type=\"submit\">\n                    <span>Send<\/span>\n                <\/button>\n            <\/div>\n        <\/div>\n\n    <\/form>\n<\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Vehicle Donation Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1896,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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