Vehicle Request Form

Please fill out the form below to reserve a vehicle.
Please allow 7 days for a response.

General Information

  1. Last Name, First Name*

  2. Family Size *

  1. Email *

  2. Mission Organization Name *

Mission Organization Website *

Which option / vehicle are you interested in leasing?*

Pre-2013 Chrysler Minivan

$10 per day + mileage fee if applicable

3 month to 1 year lease

2013 or newer Chrysler Minivan

$13 per day + mileage fee if applicable

3 month to 1 year lease

Desired vehicle release/return location:

Note: Currently over 75% of our vehicles are released from the St. Louis hub. Choosing St. Louis as ONE of your choice locations will increase your opportunity to reserve a vehicle for the dates you request. The vehicle must be returned to the location from which it was released.

  1. Your preferred location *

  2. Your 2nd choice location

  1. Your 3rd choice location

When do you need a vehicle?

Vehicle Release Date *

Vehicle Return Date *

Additional Information

As a missionary:*

Are you supported by any churches near St. Louis, Dallas, Atlanta, or Seattle? *

You selected "Yes" for the previous question. Please list the churches that support you.

Who is your sending church? *

If your sending church has a website, please provide it.*

Are you a U.S. citizen?*

Do you have a U.S. Driver’s license?*

Do you have a social security number?*

Message

Did you make a selection as to the type of vehicle you would like to reserve?