Index

PLEASE READ: DUE TO A SHORTAGE OF DONATIONS ONLY ABOUT 10% OF APPLICANTS RECEIVE A CAR. WE ARE DOING OUR BEST TO INCREASE THE NUMBER OF CARS WE GIVE AWAY. BY FILLING OUT THIS APPLICATION YOU UNDERSTAND YOU HAVE A 1 IN 10 CHANCE TO RECEIVE A CAR. AS THE NUMBER OF QUALITY DONATIONS INCREASES, SO WILL THE PERCENTAGE OF APPLICANTS RECEIVING CARS. IF YOU DO NOT HAVE A VALID DRIVER'S LICENSE PLEASE DO NOT APPLY. '

Disclaimer: All information submitted in this application is confidential unless permission is given to God’s Garage to disclose. Please do not fill out this form for anyone else. Answer the questions to the best of your ability. The more information you provide, the better we will be able to assess needs in a timely and just manner.

When a car is donated to our ministry, we will make a determination of the greatest current need. You MUST have car insurance, transfer the car into your name, and a valid U.S. state issued driver’s license to take possession of the car. Applicants must have documentation of legal residence in the U.S. For car repairs, you will be prompted to enter the VIN in this application and show proof of insurance to show ownership and liability protection before repairs are done.

I have read and understood the preceding disclaimer *

Date

3/31/2023

First and Middle Names as they appear on your Driver's License

Last Name as it appears on your Driver's License

Cell Phone Number

Email Address

Street Address

Street Address Line 2

City

State/Province

Zip/Postal

If your current address does not match your driver's license, please list the address on your driver's license for office use

DL#

State Issued

License plate of existing vehicle owned by applicant (leave blank if you do not have a car)

VIN of existing vehicle owned by applicant (leave blank if you do not have a car)

Miles driven per day

Date of Birth (2/15/1968 example)

Last 4 Digits of Social Secuirty Number

Number of kids living at home

Current Status

Single?

Married?

Divorced?

Widowed?

Separated?

If you were previously married, click this box if your divorce finalized.

Click this box if you currently employed.

Full time or part time?

Where?

Position or job

How did you hear about us?

Ages of Minor Children living with you

Any special needs children over the age of 17

Please list members of your household including age and relationship

Is this a car request or a request for service to your existing car?

Applicant story or current situation (Must be filled out completely or application will be rejected)

Have you been helped by God's Garage before?

What is your church affiliation, if any?

What is your monthly income?

Describe your car (year, make, model) and the service you are asking for

Current odometer reading/mileage

Are there special needs, such as wheelchair lift or access, or storage?

Is there anything else that you would like to tell us?

Please include 3 references with their working phone number, email address, and how you know this individual. Friend? Family? Professional?

By digitally signing below you verify that you are the applicant and you agree to the process and understand that if we cannot contact you, you will be removed from our list. If after signing your situation changes or you are no longer interested in the program, please let us know.

Digital Signature

This process could take several months, so please continue to pursue other sources of assistance