Junk Car Pickup Form – Jerry Carney – IA

jerrycarney Jerry Carney & Sons Inc. was established in 1956. We are a family owned and operated business with over 2500 vehicles available for parts removal at all times. Quality used auto parts is our specialty.

Owner Information Section
Name *			State/Province *
Address on Ownership *			ZIP/Postal Code *
City *			Phone Number *
Cell Number			Email *

Donating Your vehicle?
Yes, I want to donate my vehicle.
Name of the Licensed Charity of your choice

Vehicle Information Section
Year			Make
Model			Mileage
Licence Plate			VIN #
Location of vehicle if different than the address above.
Condition of vehicle			Comments about vehicle
There are no liens / loans outstanding against this vehicle.
I do have the ownership / title to transfer to the Authorized Treatment Facility.
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Junk Car Pickup Form – Jerry Carney – IA

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