Call: (504) 356-9566
Get Directions
Since 1981
Mon–Fri:
7:00am - 5:00pm
Sat–Sun:
Closed
Get Directions
X
About
Certifications
FAQs
Blog
Customer Experience
Clean Fleet Auto Body Shop Tour
Before and After Photos of Our Work
Testimonials
Services
Benevolence
About Benevolence
Fundraisers and Events
Benevolence Family Application Form
Contact
Locations & Hours
Online Estimate
Request An Appointment
Authorization Form
Careers at Clean Fleet Auto Body
504.888.0000
Benevolence Family Application Form
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a current driver's license?
(Required)
If yes, please attach a current DMV driving record report with at the bottom.
Yes
No
Driver's License Number
Expiration Date
State
Do you currently have auto insurance?
(Required)
Yes
No
Has your driver’s license ever been suspended or revoked?
(Required)
Yes
No
Have you had any moving violations or criminal infractions in the past two years?
(Required)
Yes
No
Are there any other members of your household with a current valid driver's license?
(Required)
Yes
No
Can you drive a manual/stick shift transmission car?
(Required)
Yes
No
This event will be covered by the media, are you willing to appear on TV?
(Required)
Yes
No
Are you currently employed?
(Required)
Yes
No
Please list the name, address and telephone number of your employer/supervisor.
Confirmation
(Required)
All interested applicants must send a 1-page narrative explaining why the lack of reliable transportation interferes with your current and future economic status, and how receiving this automobile will assist you in becoming self-sufficient, along with their resume, and current DMV driving record report. These can be dropped off to Clean Fleet Auto Body at 4432 Hearst Street Metairie LA 70001, faxed to 504-888-0507, emailed to davidr@cleanfleetautobody.com, or attached to this form.
All applications are due by October 15, 2021.
Yes, I understand
File Upload
Please upload any relevant documents you have here.
Drop files here or
Select files
Accepted file types: jpg, png, pdf, txt, doc, docx, Max. file size: 50 MB, Max. files: 10.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.