Mechanics Ministry Benevolence Application
Application for reduced labor rate
Date of Application
Mechanics ministry benevolence rates are valid for 6 months from the date on the application.
Date
MM
/
DD
/
YYYY
Personal Information
Applicants Name and Contact Information
Name
Your answer
Address
Your answer
City State Zip
Your answer
Phone Number
Your answer
Cell Phone
Your answer
Employment Information
Employer
Who is your current employer?
Your answer
Employer Address
Your answer
Employment History
How long have you been working there?
Your answer
Spouse or other Adult
List the name of your spouse or other adult in the household
Your answer
Spouse or other Adult Employer
Who is their employer?
Your answer
Employment History
How long have they been working there?
Your answer
Vehicle Information
Make
Your answer
Year
Your answer
Model
Your answer
Licence Number
Include state car is licensed in.
Your answer
Color
Your answer
Mileage
Your answer
Method of payment
We are sorry but we are unable to make payment arrangements
Household Information
Depending on the number of people in your immediate family and your household income, you may be eligible for a reduced hourly rate discount for service on your vehicle. Some services are not eligible for the discount and have a flat fee.
Number of family members living in your house including yourself
Your answer
Names of Household Member
Include their name, age, and their relationship to you
Your answer
Gross Monthly Income
Include the total income of all of the household members. This includes child support, disability income, and social security. Verification of income is required in order to process your application.
Your answer
Consent Form
I hereby give my consent to Cedar Park Assembly of God Church to share the information contained in my application form including other material I have provided to support my application for aid with Cedar Park Pastors, volunteers and staff members, churches or agencies as Cedar Park Church , in the exercise of its reasonable discretion, might see fit. I also give Cedar Park Church express consent to verify any information contained on this form, including attachments or supplements I have provided, in order to determine the extent, legitimacy and duration of my need.
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