Nate’s Community Garage Application

Nate’s Community Garage Application

501(c) 3
VERY IMPORTANT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- Verification of all forms of income
- Proof of vehicle ownership & Driver's License
- Grant up to $500.00 yearly
- Financial assistance not provided for routine or preventative maintenance
- Veterans provide VA card or DD214
- All vehicles must undergo a full 1-hour inspection, participant will receive a full report & estimate with photos & videos of repairs needed. Cost is $29.99 plus tax paid by participant
- Participant is required to pay 25% or the remaining balance of repair bill
Your name cannot be added to the waiting list until we receive all documents
PERSONS IN FAMILY/HOUSEHOLD INCOME GUIDELINE
For families/households with more than 8 persons, add $4,540 for each additional person.
1 $12,880
2 $17,420
3 $21,960
4 $26,500
5 $31,040
6 $35,580
7 $40,120
8 $44,660
Today's Date *

Month Day Year
Name *

First Last
Spouse/Partners Name

First Last
How many people live in your household? *
How many under 18? *
How many over 18? *
Address *

Street Address

Street Address Line 2

City State

Zip Code
County *
Phone Number *
Email
example@example.com
Are you a Veteran? *
Income Information
Employment Status *

Part-time Full-time Unemployed Disabled
Employer
TYPE N/A IF YOU DON'T HAVE ONE
Other Income (child support, SSI, RSDI, unemployment etc) *
TYPE N/A IF YOU DON'T HAVE ANY
Total Gross Income for your household *

Vehicle Information
Make
Model
Year
Mileage
What are your concerns with the vehicle? *
Income Verification *

Cancel of
License/ Vehicle Ownership *

Cancel of
Other supporting documents *

Cancel of
How did you hear about Nate’s Garage? *
WAIT...before you submit, please read

*NCG does not provide financial assistance for preventative maintenance, it's designated to help with safety repairs only. *Applications will be processed in the order they are received, this means your name will go on a waitlist. Just because you fill out an application does not guarantee approval. It is the applicant's responsibility to make sure all contact information is up to date. When you are next in line you will be contacted and have 30 days to respond to the appointment request, if you do not respond your name will go to the bottom of the list and you may need to reapply. *NCG reserves the right to deny any car repair. Some cars are simply not worth the investment, with limited funds, NCG must place investment where it is likely to make the most positive impact. The repair must be essential to the participant's ability to obtain and retain employment and or education and must have a reasonable chance of extending the car's functional life. *I hear by give NCG and it's parent company Nate's Garage LLC consent to verify any information contained in this application and all additional supporting documents. I hear by give my consent to NCG and it's parent organization Nate's Garage LLC to share non identifying information contained in this application with investors, private stakeholders, sponsors, grantors etc. I also give permission to NCG to take, use and publish photos or videos that may have been taken by a representative from NCG for education and or promotional purposes.
Testimonials are important for future participants, funders, donors, stakeholders and us, we can always improve and getting feedback only helps us do better. We will not use your full name and will remove any personal or identifying information. Testimonials allow us to use your words to show how Nate’s Community Garage impacts peoples lives. You will receive a follow up via email or mail please let us know your preference.

Email Mail
Payment agreements for charges incurred at Nate's Garage LLC must be paid in full before vehicle pick up. If the account is not paid in full your vehicle will not be released. Your vehicle will not be released to anyone other than applicant unless prior approval. Vehicles that are not picked up 24 hours after repairs have been completed can incur a $40 a day storage fee. Nate's Garage LLC will have full discretion for unpaid accounts and will take necessary action to collect any unpaid balance.
Signature

Clear
Approval Process
Amount Awarded
RO total
Should be Empty:

Nate’s Community Garage Application

Income Information

Vehicle Information

WAIT...before you submit, please read