Jesus' Labor Of Love Repair Request
Please fill this out
to schedule your
repair at the best
suited repair center
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Name: First and Last Please *
How Did You Hear About US?
Address/City/State *
City *
State *
Zip Code *
Phone # *
Email Address *
Jesus Labor of Love Category *
What is going on in your life that caused you to contact us for help? *
What is your car doing that concerns you? *
Vehicle Year Make and Model *
Church Affiliation (Not Required)
Church Phone Number (Not Required)
Please Share A Couple of References with us
Reference 1 *
Reference 1 Phone # *
Reference 2 *
Reference 2 Phone # *
To Be Eligible you need to have a valid Drivers License and Liability Insurance on your car
Driver License # and State *
Liability Insurance Company *
Policy Number *
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This form was created inside of Truth Broadcasting Corp.