Vehicle Repair Application

Thanks to the generous support of Sioux Empire community members, we are able to help qualified single-parent families in need of emergency car repair. Complete the below application to apply for a one-time Angel Repair of up to $500.  If you have any questions or need help filling out the form, please contact us at (605) 941-4318.

MM/DD/YYYY
Please list your dependent children's names and ages living with you. If you have no dependent children, answer NA
If there are no other adults in your household, answer NA
Example: Chevrolet, Impala, 2008
Example: Traffic Violation, November, 2012
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
Answer NA if not applicable
(Net Income) - (Total Expenses) = Cash Available

Wheels to Work does not discriminate in its policies and programs on the basis of race, color, gender or religion.