Vehicle Repair Request Form Please complete the below form in its entirety, if you have any questions please contact your Chariots4Hope representative. Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *Insurance Company *Insurance Policy # *Name of Agent *Phone Number of Insurance Company *Vehicle Year *Make and Model *Vehicle VIN # *Vehicle Mileage *Vehicle Dropoff Availability (next 2 weeks) *Describe current problem with vehicle (be specific) *Any other prior issues you have noticed with your vehicle?Additional CommentsSubmit