Repair Request
This is where the Disabled Veteran, our customer simply requests a vehicle repair, providing some basic information, and the process of getting you back on the road, safe, and satisfied for no cost begins.
Mission Payback guarantees to cover 100% of the labor for the repair. We rely on donations to cover parts and supply costs. All options will be explored on a case-by-case basis, to ensure every Veteran receives the best service. 100% of all donations go to Disabled American Veterans. 
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Email *
Personal Information
Name *
Address *
City *
State *
Zip Code *
Vehicle Information
Year *
Make *
Model *
License Plate Number and State *
Vehicle Identification Number - VIN
This helps with ordering parts to ensure correct fit.
Repair Request - Brief explanation of issue needing repair. (We will follow-up with questions and to schedule thru email) *
VA Benefits Letter - Proof of Disability Rating and % 
This information will not be sold or shared and is only to validate the customer and keep the program honest and legitimate. Our mission is to ensure 100% of donations go to Disabled Veterans. 
- VA I.D. Cards, Entitlement & Award Letters, C&P Benefits Letters Acceptable
 *
Required
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