Vehicle Repair Summary Vehicle Repair Summary ReportOnce the vehicle safety related repairs have been completed, use this form to report the requested final information.Please enable JavaScript in your browser to complete this form.1Contact information2Repair Information3Financial Information4Wrap-It UpAutomotive Repair Shop *Christian Brothers Automotive - ShawneeAutomotive Repair Shop Contact Name (Who is completing this form?) *FirstLastClient / Customer Name *FirstLastNextEnter the date the vehicle was dropped off at the repair shop. *mm/dd/yyyyEnter the date the vehicle repairs were completed and vehicle was picked up. *mm/dd/yyyyBriefly describe the repairs that were completed. *For planning purposes only, please answer the following questions.These questions are solely for the purposes of helping Moneytalk be prepared for potential additional assistance requests as well as reminding the client of upcoming maintenance to be completed.Are there safety related repairs that were not completed? *Yes, there are more safety related repairs that need to be completedNo, all needed safety related repairs are completeBriefly describe any safety related repairs that were not completed. Estimate how soon might these repairs need to be completed. *Are there other non-safety repairs that were not completed? *Yes, there are other non-safety related repairs that need to be completedNo, all needed repairs are completeBriefly describe any non-safety related repairs that still need to be completed. Might any of these repairs become a safety related issue? *PreviousNextMark all that apply *Donated or discounted partsDonations from friends or familyDonated or discounted laborDonation from Moneytalk Financial FoundationsClient paid entire remaining balance, Repair bill is paid in full.Donation from sub-program supportClient paid a portion and will be using a payment plan for the remaining balance.Conflicting options were selected. Please correct.The "Client paid entire remaining balance, Repair bill is paid in full" and "Client paid a portion and will be using a payment plan for the remaining balance" should not both be selected. Only one can be true.Enter total cost of the repairs (without discounts or donations applied). *Enter amount of discounted or donated parts. *Name of the company who donated or discounted the parts. *Enter amount of discounted or donated labor provided by automotive repair shop. *Enter amount donated by family or friends. *Enter amount donated by Moneytalk Financial Foundations. *Enter amount donated by sub-program support. *Sub-programs are city resident specific (such as Shawnee Car Care) or other subset of residents or customers.Select sub-program supporting this vehicle repair.Shawnee Car CareEnter amount paid by client when vehicle was released. *Enter amount to be paid through the payment plan. *Total amount should match "Total cost of repairs" listed above.$ 0.00PreviousNextWrap-it UpUpload a copy of the repair invoice * Click or drag a file to this area to upload. Upload a copy of estimates provided for work yet to be completed. Click or drag a file to this area to upload. If you created estimates in a separate document from the repair invoice for work that still needs to be completed, please upload it here. This will help us work with the client to be prepared to pay for these repairs and/or anticipate upcoming vehicle repair financial assistance requests.Upload a copy of the payment plan * Click or drag a file to this area to upload. Anything else you would like for us to know?Sign below to certify completion of agreed upon vehicle repairs. *Clear SignatureSubmit If you would rather complete a paper copy of the form, print the PDF document. Or complete the form online using the fillable PDF. Vehicle Repair Summary