Grace Garage Application

We currently offer OIL CHANGE and MULTIPOINT INSPECTION services to single moms, widows, and wives of deployed military. TO AVOID DELAY IN THE APPLICATION PROCESS ALL QUESTIONS MUST BE ANSWERED. Proof of Insurance is required in order to process your application. Actualmente ofrecemos servicios de CAMBIO DE ACEITE e INSPECCIÓN MULTIPUNTO para madres solteras, viudas y esposas de militares desplegados. Una vez que recibamos y revisemos esta solicitud, nos pondremos en contacto para programar una cita. ----> We offer services to people living in the following zip codes <---- 77373, 77380, 77381, 77382, 77384, 77385, 77386, 77388, 77389 *If you are a member of Grace Woodlands, the zip code area of service does not apply.

Your name *

Email address *

Phone number *

Date Of Application *

Address *

How long have you lived at this address? / Cuanto tiempo has vivido en esta dirección? *

FAMILY INFORMATION / INFORMACIÓN DE LA FAMILIA

Please list household members names and ages: *

Are you a single mom? *

Personal Status *

OTHER INFORMATION / OTRA INFORMACION

Are you employed at Grace Woodlands? / ¿Estás empleado en Grace Woodlands? *

Do you attend Grace Woodlands Church / Asiste a la iglesia Grace Woodlands? *

TELL US ABOUT YOUR VEHICLE / DETALLES DE TU VEHICULO

Have you requested assistance elsewhere? / Ha solicitado ayuda en otro lugar? *

Have we serviced your vehicle in the past? / Hemos rendido servicio a su vehículo en el pasado? *

Year / Año *

Make / Marca *

Model / Modelo *

License Plate Number and State (REQUIRED) / Placa y Estado (NECESARIO) *

VIN Number (REQUIRED) / Numero de VIN (NECESARIO) *

(Your VIN number is listed on your insurance card / El número de VIN esta en la tarjeta del seguro)

Current Mileage / Actual Millaje (NECESARIO) *

Do you have current insurance? (REQUIRED) / Su carro esta asegurado? (NECESARIO)? *

INSURANCE IS REQUIRED TO PROCESS YOUR APPLICATION.
SEGURO ES NECESARIO PARA TRAMITAR SU SOLICITUD.

Is your registration up to date? / El registro esta actualizado? *

When does your registration expire? / Cuando se vence el registro? *

When was your last oil change? (NECESSARY) / Cuando fue la ultima vez que le cambio el aceite? (NECESARIO) *

Is your check engine light or other indicator light on? / Tiene encendida la luz de revisión del motor u alguna otra luz indicadora en su vehículo? *

Has your vehicle had major maintenance or repairs completed in the last 6 months? / Se le han realizado grandes reparaciones o mantenimiento a su vehículo en los últimos 6 meses? *

What work are you requesting? Please explain the problems you are currently experiencing with your vehicle. / Por favor, explique el problema que tiene su vehículo actualmente. *

Be as thorough as possible.

PRAYER REQUEST / PETICIÓN DE ORACIÓN

How can we pray for you? / Como podemos orar por ti? *

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