Application

Fill the form below to start using Low Income Auto Repair mobile application. Once you finish your registration here, you can continue and sign in to mobile application.

Application form

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Account type *

Customer
Provider

First name *

Last name *

Email *

Phone *

Password *

Password

Confirm Password

Terms & Conditions *

I agree to the terms & conditions

Terms & Conditions *

I agree to the terms & conditions

Confidentiality agreement *

I agree to the confidentiality agreement

Date of birth *

Sex *

Living situation *

Address line 1 *

Address line 2

City *

State *

ZIP code *

Monthly income *

Company name *

Facility ID *

Company address line 1 *

Company address line 2

Company city *

Company ZIP code *

Company state *

Service type *

Mechanical repair
Quick lube
Towing service

Select main type of service for your workshop.

Workshop adress is same as company address *

Yes
No

Workshop address line 1 *

Workshop address line 2

Workshop city *

Workshop ZIP code *

Workshop state *

Opening hours

Open 24/7 *

Yes
No

Sunday

Closed *

Yes
No

Sunday from *

Sunday to *

Monday

Closed *

Yes
No

Monday from *

Monday to *

Provider Layout Wednesday

Tuesday

Closed *

Yes
No

Tuesday from *

Tuesday to *

Wednesday

Closed *

Yes
No

Wednesday from *

Wednesday to *

Thursday

Closed *

Yes
No

Thursday from *

Thursday to *

Friday

Closed *

Yes
No

Friday from *

Friday to *

Saturday

Closed *

Yes
No

Saturday from *

Saturday to *