* Marital Status Select one Single Married Divorced Separated Widowed
* Mobile Carrier Select a mobile carrier Unknown No Texting 3 Rivers Tel. Coop., Inc. Alaska Communication Systems American Messaging Appalachian Wireless Arch Wireless AT&T Bell Mobility Canada Bellsouth Mobility Bluegrass Cellular Boost C Spire Wireless Carolina West Wireless CBeyond Cellcom Cellular Network Partnership Cellular One (Illinois) Cellular One of NE Arizona Cellular South Centennial Wireless Chariton Valley Cellular (Bellcore Assigned) Chat Mobility Cincinnati Bell Claro - Puerto Rico Comcast (Xfinity) Mobile Commnet Wireless Consumer Cellular (AT&T) Consumer Cellular (T-Mobile) Copper Valley Cellular Cricket Dobson Tel. Co. Docomo Pacific (Guam Wireless) Eos Mobile Family Mobile Fido Flat Wireless (ClearTalk) Freedom Mobile GCI GCI Communication Corp. Globalstar USA, Inc. Gold Star Communications, LLC Google Fi H2O Wireless Illinois Valley Cellular Inland Cellular Iowa Wireless Services Jasper/Cricket Keystone Wireless Kitty Wireless Koodo Mobile Leaco Rural Telephone Cooperat Metro PCS Mid-Tex Cellular, Ltd. Mobile Nation MTN MTS Communications N-Telos Nex-Tech Wireless Nextel Non-wireless Phone NW Missouri Cellular O2 (UK) Optus Mobile Orange (UK) Page Plus Pine Telephone Pioneer Cellular Plateau Wireless PR Wireless (Open Mobile) Public Mobile Pure Talk Qwest Republic Wireless Republic Wireless/Bandwidth.com (Sybase) Rogers Safelink Sagebrush Cellular (Nemont) SaskTel Simple Mobile Smart Telecom Solo Southern Communications Services, Inc. Spectrum Mobile Sprint SRT Communications, Inc. Straight Talk Suncom T-Mobile T-Mobile (UK) Telrite Wireless Telus Mobility Thumb Cellular Ting Total Wireless Tracfone UBET Wireless Unicel Union Wireless United Wireless Communications US Cellular Verizon Viaero Wireless Virgin Mobile Virgin Mobile (Canada) Virgin Mobile (UK) Vodacom Vodafone (UK) West Central Wireless Wind Mobile z-AT&T (alt) z-At&t (alt2) z-Sprint (alt)
OIL CHANGE/SERVICE WAIVER - I understand Lizella Baptist is not a professional automotive service. Further, that this is not a substitute for regular maintenance inspections. I agree to hold harmless and free of liability Lizella Baptist Church, Inc, its volunteer, staff and representatives from any and all damages, loss, or unintentional negligence. Lizella Baptist has disclaimed all implied warranties, including the implied warranties of merchantability and fitness for a particular use.
* Waiver Acceptance/Release of Liability Select one Yes No
* Time Slot Select one 8 AM [No longer available] 8:15 [No longer available] 8:30 AM [No longer available] 8:45 [No longer available] 9 AM [No longer available] 9:15 [No longer available] 9:30 AM [No longer available] 9:45 [No longer available] 10 AM [No longer available] 10:15 [No longer available] 10:30 AM [No longer available] 10:45 [No longer available] 11 AM [No longer available] 11:15 [No longer available] 11:30 AM [No longer available] 11:45 [No longer available]