Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the application and access it in the online editor.
2. Review the program options carefully. You need to choose either vehicle withdrawal, which can provide up to $1,500 for qualifying income-based applicants, or repair assistance that offers up to $1,200 for emissions-related repairs depending on vehicle age.
3. Fill in your personal information in the designated fields. Provide your first name, last name, address, middle initial, driver's license number or identification, state, zip code, city, date of birth, and daytime phone number.
4. If applicable, complete the co-owner's details with their last name, first name, middle initial, driver's license number or identification, and date of birth.
5. Provide vehicle information by entering the year, make, model, vehicle identification number (VIN), and California license plate number.
6. Fill out the income verification section. Indicate the number of people living in your household, including yourself, and enter your monthly and annual gross household income.
7. Read and understand the signature requirements for the application. You must acknowledge that the information you provided will be used to evaluate and verify your eligibility and that you may need to submit additional documentation to the Bureau of Automotive Repair.
8. Once all fields are completed accurately, review your application for any errors. Ensure all required sections are filled out.
9. After confirming your information, save your changes, and you can then proceed to download, print, or share the completed form as necessary.

Complete your application for assistance online today.