Car & Service Application
Disclaimer: All information submitted to the car care ministry is confidential. Please 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. If you are selected to receive a car, we will contact you and ask you to obtain insurance for the vehicle. You MUST have insurance, transfer the car into your name, and a valid driver’s license to take possession of the car.

This ministry is run by volunteers with a heart to serve Jesus by providing help to those in need, so please be patient as you wait. If you have not heard back after 1 year and you are still in need, please feel free to reapply.

I have read and understood the preceding disclaimer *

Street Address *
Street Address