PD Active

Contact Information

Oakland

California

website

PD Active is a group of people impacted by Parkinson’s disease in the Oakland/Berkeley region. We create and improve programs that support and care for people with Parkinson’s, family and caregivers. We believe that we are our own best advocates, and that acting on our own behalf fosters independence, dignity and respect while preventing isolation and depression, and that we are strongest and most content when we work together.

Donate a Car to Charity
Please fill out the form below to donate a car!

Name*
Prefix First Middle Last Suffix
Email*

Phone*
Work Phone
Cell Phone
Address*
Street Address City State ZIP Code

Business Name

Business Phone
Vehicle Year*
Vehicle Make*

Vehicle Model*

Vehicle Color*

Numer of Doors
Current Mileage*

Registration*

Yes

No
State Vehicle Registered
State

Registration Expiration Date*
MM slash DD slash YYYY

Why don't you have the Registratrion?
Do You Have the Certificate of Title (Pink Slip)?*

Yes

No
Is the Vehicle in Running Condition?*
Why don't you have the Pink Slip?
Why isn't the Vehicle in Running Condition?
Vehicle Identification Number*

License Plate Number

Describe Mechanical Issues, if any
Describe Condition of Body
Describe Condition of Paint
Describe Condition of Interior
To Which Charity Would You Like to Donate Your Vehicle?*
Is the Vehicle Located at the Address Above?*

Yes

No
How did you hear about our car donation program?

Notate the address where the vehicle is located
Street Address City State ZIP Code

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