If you have a roadworthy handicap vehicle that is adapted for use by those with disabilities, please fill out the following form. Please make sure to scroll down to fill in all the necessary information

Vehicle Information
Type of Vehicle
Year:
Model:
Mileage:
VIN:
Any repairs needed:
Estimated Cost for Repairs:
Estimated Value of Vehicle:
​Drivability:
​Picture:
Please upload pictures of the vehicle or send from your phone to specialkid@gmail.com
Name & Address
First Name
Last Name
Email
Address
City
State
Zip
Phone Number
Comments
How did you hear about us?


Comments
Security Check:

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