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Godsend Garage Assistance Request
This form is to request automotive services from Godsend Garage, a ministry of Crossroads Community Church.
We are only able to service guests in the Kokomo vicinity.
Only 1 vehicle is allowed per application.
* Indicates required question
Email
*
Record my email address with my response
What is your full name?
*
Your answer
What is your address, including city and zip code?
*
Your answer
What is your phone number, including the area code?
*
Your answer
Are you a widow or single mother?
*
Widow
Single mother
Neither
What are the names and ages of the people in your household, including yourself?
*
Your answer
What is the year, make, and model of your vehicle?
(example: 2013 Ford Explorer)
*
Your answer
Describe the problem with your vehicle.
*
Your answer
What happened to you that put you in a position to request help?
*
Your answer
Please list the sources and amounts of your household income.
*
Your answer
How did you hear about Godsend Garage?
*
Your answer
How else can we pray for you?
*
Your answer
If accepted, I will be put on a waiting list.
*
I understand
Required
If accepted, it is my responsibility to pay for any and all parts used in the repair. (Labor is free).
*
I understand
Required
Due to the volume of applications and garage capacity, the following conditions apply:
- I am not guaranteed to receive service.
- I release Godsend Garage from any liability.
- I understand my application will remain on file for 1 year.
*
I understand
Required
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