Vehicle Application

First & Last Name

Street Address

City

State

ZIP Code

School District

Email Address

Phone Number

How did you hear about Community Auto?


Some basic information

Birthday

Gender
 Female Male

Ethnicity

Are you a military veteran?
 Yes No

Education (select one)

Please tell us a little more about yourself and how owning a car could impact your life:


Tell us about your household

How many people, including yourself, live at your residence?

Additional Household Member #1
Name

Birthday

Relation

Additional Household Member #2
Name

Birthday

Relation

Additional Household Member #3
Name

Birthday

Relation

Additional Household Member #4
Name

Birthday

Relation

Additional Household Member #5
Name

Birthday

Relation


Tell us about your employment and household income:

Employment Status

Current Employer

Current Employer's Address

Current Occupation

What is your hourly rate ($/hr)?

Hours per Week

Previous Employer

How long were you at your previous employer?

Previous Employer's Address

Previous Occupation

What was your hourly rate ($/hr)?

Hours per Week


For your entire household, please tell us about other sources of monthly income. List the total income for each of the following:

Child Support:

SSI (Suplemental Security Income):

Unemployment:

Workers' Compensation:

Pension:

Social Security:

Disability:

Public Assistance (TANF):

Does anyone in your household have a vehicle?
 Yes No

How do you get to work/school?

Are you a Ways to Work client?
 Yes No

Have you purchased a vehicle from Community Auto in the past?
 Yes No

How much money do you have available to buy a vehicle?

Important information about our program

1. The price of Community Auto vehicles includes  current inspection stickers, 1-year AAA+ membership, and car seats for dependent children.   Select vehicles will also include a twenty four-month/26,500 mile limited warranty.

2. Applicants will be required to attend a Car Care Workshop prior to purchasing a vehicle.

3. Community Auto cannot finance, accept trade-ins or arrange payments. Vehicles must be paid for in full at the time of purchase.

4. Community Auto is not responsible for the maintenance needs of the vehicle during the warranty or for repair or maintenance after the life of the warranty.

If you are interested in purchasing a car with Community Auto,  please provide the following information.

In order to complete your vehicle application you must email, mail or fax us your proof of income, (which is your most recent four weeks of pay stubs), and proof of funds available to purchase a vehicle.

Mail to: 11490 Perry Highway Suite #7 Wexford, PA 15090
Email to: cars@nhco.org
Fax to: 724-443-8304