CSPM Oil / Filter Request
Fill out this "CSPM Oil/Filter Request" form. Requests are based on need and association with Central Church. If your request is approved, you will receive a coupon which is redeemable for Oil/Filter Change for standard oil (not eligible for any type of synthetic oil) at either of two Hendrick Automotive Group locations: Rick Hendrick City Chevrolet at 5101 E. Independence Blvd. Charlotte, NC 28212 or Hendrick Honda at 8901 South Blvd. Charlotte, NC 28273.
Name *
Your answer
Phone / Best time to reach you *
Your answer
Email *
Your answer
Home address *
Your answer
Name and ages of children *
Your answer
Please give the year, make, and model of your car (ex. 2005 Honda Accord) *
Your answer
Current Mileage of your car *
Your answer
When was the last time the oil was changed? *
Your answer
On a scale of 1 to 10 (1 being not very much and 10 being very much) how serious is your financial need? *
Your answer
Please describe your involvement / relationship with Central Church. *
Your answer
Please give us two names of people at Central Church who know you. *
Your answer
If approved, how would you like to receive a coupon? Please place a check mark by your choice. *
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