Service Request Form

Service Request Form

Mechanics of Faith
Location: 102 Sharon Road, King William VA 23086

New clients, please fill in this form. Please understand our staff works extremely hard to get back to applications in a timely manner, but we are incredibly busy and there might be delays of several days to several weeks before you hear from us to schedule your vehicle for service. We typically reply to applications on Tuesdays and Thursdays.

If you are a returning client, please utilize our returning client form or give us a call to schedule your appointment.
Driver Information
Driver's Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you currently living in your vehicle.
Care Partner (If Applicable)
Optional
Marital Status
Gender
Ethnicity
How did you hear about us
Number of household members
Household yearly Income
Employment Status
Car Details
Year
Make
Model
License Plate Number
Color of Vehicle
VIN (can be found on registration or on vehicle near the bottom left windshield)
If you need something not listed below, please explain as we offer many services not listed below.
Service Needs (If known, these are not all our services)
If Other, please explain
If you are unsure of the repairs your car made need please just type diagnostic
To receive automotive repair at Mechanics of Faith, you must receive government assistance or referred to us via a community partner.
Check this box if you will supply the below information upon arriving for service.
SNAP/Medicaid (Documentation)

Cancelof
Vehicle Registration (Documentation)

Cancelof
Driver's License (Front Only)

Cancelof
Covenants
Driver's Signature or 3rd Party
Date Signed

MonthDayYear
Date
If a 3rd Party is filling our this form on the behalf of the client please provide the below data.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mechanics of Faith helps anyone in need that meets our guidelines regardless of race/ ethnicity, religion, or gender.
Should be Empty:

Service Request Form

Driver Information

Car Details

If you need something not listed below, please explain as we offer many services not listed below.

To receive automotive repair at Mechanics of Faith, you must receive government assistance or referred to us via a community partner.

If a 3rd Party is filling our this form on the behalf of the client please provide the below data.