If you are interested in purchasing a car with us please provide the following information.

First Name
Last Name
Address
City
State
ZIP Code
School District
Email Address
Daytime Phone
Evening Phone
Who Referred You to Us?
Current Place of Employment
Name of Supervisor
Supervisor's Phone Number
Employment Status
Hours Per Week
How many people, including yourself, live at your residence?
Please include Names and Date of Birth for people living at your residence. Make sure to include yourself.
Please select your pre-tax household income (Please email, mail or fax your proof of income to us: see below)
Gender
Race
How much money do you have to buy a vehicle?
Which type of vehicle best suits your needs?
Do you have a valid and current Driver's License?
Do you currently have car insurance?
Do you have a running and reliable car?
How do you get to work/school?
Is public transportation available from your home to your work/school?
Do you need car seats?
Can you drive a manual transmission (Stick Shift)?
Are you a Family Services Ways to Work client?
Please explain why you are applying for a vehicle from us.
By signing your name, you are providing an electronic signature for all of the information contained in your application.

In order to complete your vehicle application you must email, mail or fax us your proof of income. Please provide one month of current income.

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