I'm Ready to donate Service Manager or Authorised Person Information Service Manager or Authorised Person First Name: Dealership Service Manager or Authorised Person Last Name: Street Number: Street Name: City/Suburb: Please nominate the State, Region and Area as appropriate: ℹ Please select a nearby Region and an Area, where applicable, so that an appropriate Recycler within your vicinity can be contacted. ️ -- select your State -- Australian Capital Territory Northern Territory New South Wales Queensland South Australia Tasmania Victoria Western Autralia -- select your Region -- Oaks Estate Canberra -- select your Region -- Katherine Darwin Alice Springs -- select your Region -- Sydney (incl. Greater Sydney) Northern NSW Central NSW Southern Highlands South Eastern Western NSW -- select your Region -- Brisbane (incl. Greater Brisbane) North Queensland Coastal Queensland Central Queensland South Western South East -- select your Region -- Adelaide (incl. Greater Adelaide) Country Central Country North The Riverland Barossa South East Mid North Eyre Peninsula -- select your Region -- North/North East North West South -- select your Region -- Melbourne (incl. Greater Melbourne) Mornington Peninsula Geelong Districts Surf Coast Warrnambool Districts Ballarat Districts Bendigo Districts Western Districts Wimmera Mallee Wimmera Shepparton Districts Wangaratta Districts Seymour District South Gippsland Warragul District Traralgon District East Gippsland -- select your Region -- Perth (incl. Greater Perth) Bunbury District Bussellton District Margaret River District South East Northern Central Pilbara/Kimberley -- select your Area -- Northern Sydney Metropolitan Area Eastern Sydney Metropolitan Area Western Sydney Metropolitan Area Southern Sydney Metropolitan Area -- select your Area -- Far North Coast North Coast Northern Rivers Mid North Coast Central Coast Hunter/Newcastle Windsor/Richmond -- select your Area -- North Eastern Bathurst/Orange Central Eastern -- select your Area -- Campbelltown/Camden Penrith & Blue Mts. -- select your Area -- Snowy Mountains South Coast -- select your Area -- North West Dubbo and Western Plains Far West -- select your Area -- Northern Brisbane Metropolitan Area Eastern Brisbane Metropolitan Area Southern Brisbane Metropolitan Area Western Brisbane Metropolitan Area -- select your Area -- Capricorn Cairns Townsville Whitsundays Rockhampton Mackay Bundaberg Gladstone -- select your Area -- Wide Bay Burnett Fraser Coast Sunshine Coast Gold Coast -- select your Area -- Northern Adelaide Metropolitan Area Eastern Adelaide Metropolitan Area Western Adelaide Metropolitan Area Southern Adelaide Metropolitan Area -- select your Area -- Northern Melbourne Metropolitan Area Eastern Melbourne Metropolitan Area Western Melbourne Metropolitan Area Southern Melbourne Metropolitan Area -- select your Area -- Northern Perth Metropolitan Area Eastern Perth Metropolitan Area Southern Perth Metropolitan Area Postcode: Email: Confirm Email: Contact Number (Must be a mobile number, required to upload images): ℹ This number will be used for all further correspondence. An SMS will be sent out to this number with details of the next steps. If you do not have an Australian contact number please contact our helpdesk. Dealership Name & Branch: Pickup Details and Address is same as above Service Manager or Dealer Contact Person First Name: Service Manager or Dealer Contact Person Last Name: Vehicle Pickup Location Street Number: Pick up Street Name: Pickup City/Suburb: Pickup State: -- select your State -- Australian Capital Territory Northern Territory New South Wales Queensland South Australia Tasmania Victoria Western Autralia Pickup Region: -- select your Region -- Oaks Estate Canberra Pickup Region: -- select your Region -- Katherine Darwin Alice Springs Pickup Region: -- select your Region -- Sydney (incl. Greater Sydney) Northern NSW Central NSW Southern Highlands South Eastern Western NSW Pickup Region: -- select your Region -- Brisbane (incl. Greater Brisbane) North Queensland Coastal Queensland Central Queensland South Western South East Pickup Region: -- select your Region -- Adelaide (incl. Greater Adelaide) Country Central Country North The Riverland Barossa South East Mid North Eyre Peninsula Pickup Region: -- select your Region -- North/North East North West South Pickup Region: -- select your Region -- Melbourne (incl. Greater Melbourne) Mornington Peninsula Geelong Districts Surf Coast Warrnambool Districts Ballarat Districts Bendigo Districts Western Districts Wimmera Mallee Wimmera Shepparton Districts Wangaratta Districts Seymour District South Gippsland Warragul District Traralgon District East Gippsland Pickup Region: -- select your Region -- Perth (incl. Greater Perth) Bunbury District Bussellton District Margaret River District South East Northern Central Pilbara/Kimberley Pickup Area: -- select your Area -- Northern Sydney Metropolitan Area Eastern Sydney Metropolitan Area Western Sydney Metropolitan Area Southern Sydney Metropolitan Area Pickup Area: -- select your Area -- Far North Coast North Coast Northern Rivers Mid North Coast Central Coast Hunter/Newcastle Windsor/Richmond Pickup Area: -- select your Area -- North Eastern Bathurst/Orange Central Eastern Pickup Area: -- select your Area -- Campbelltown/Camden Penrith & Blue Mts. Pickup Area: -- select your Area -- Snowy Mountains South Coast Pickup Area: -- select your Area -- North West Dubbo and Western Plains Far West Pickup Area: -- select your Area -- Northern Brisbane Metropolitan Area Eastern Brisbane Metropolitan Area Southern Brisbane Metropolitan Area Western Brisbane Metropolitan Area Pickup Area: -- select your Area -- Capricorn Cairns Townsville Whitsundays Rockhampton Mackay Bundaberg Gladstone Pickup Area: -- select your Area -- Wide Bay Burnett Fraser Coast Sunshine Coast Gold Coast Pickup Area: -- select your Area -- Northern Adelaide Metropolitan Area Eastern Adelaide Metropolitan Area Western Adelaide Metropolitan Area Southern Adelaide Metropolitan Area Pickup Area: -- select your Area -- Northern Melbourne Metropolitan Area Eastern Melbourne Metropolitan Area Western Melbourne Metropolitan Area Southern Melbourne Metropolitan Area Pickup Area: -- select your Area -- Northern Perth Metropolitan Area Eastern Perth Metropolitan Area Southern Perth Metropolitan Area Pickup Postcode: Pickup Mobile/Contact Number: Available Pickup Date: Vehicle Information Search by Rego or VIN Vehicle Registration Number (Rego): Vehicle State: -- select State -- Australian Capital Territory Northern Territory New South Wales Queensland South Australia Tasmania Victoria Western Autralia Check Rego OR VIN: ℹ A VIN will never contain the alphabets I, O and Q. Check VIN Year: -- select Year -- Body Type: Make: Model: Colour: Kilometers: Condition of Vehicle: Running Complete with no missing parts Towable Additional Notes: Declarations The following conditions must be agreed upon to participate: I hereby declare that I am an authorized representative of the owner of the above vehicle and that I have the absolute right to transfer ownership and possession of the vehicle. I confirm and agree that the vehicle is free and clear of all liens and encumbrances. Notes Payment will be made to ARAA’s Bailey’s Day Donation account. Funds will be remitted Monthly to Monash Health Foundation Vehicle Keys must be presented to the Recycler upon pickup of the vehicle. The Service manager or person authorised must be present to handover the vehicle. Thank you for verifying. This helps keep our website secure. Submit
