Full Application

More Than Wheels currently serves all of New Hampshire, and adjoining areas of Vermont, Maine, and Massachusetts.

How did you hear of More Than Wheels?: *

First Name: *

Last Name: *

Home Phone Number: *

Home Phone Number Prefix: *

Home Phone Number Line Number: *

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Cell Phone Number:

Cell Phone Number Prefix:

Cell Phone Number Line Number:

clear

Other Phone number where you can be reached:

Other Phone number Prefix:

Other Phone number Line Number:

Email address: *

Address: *

City: *

County: *

State: *

Zip code: *

Number of years at current residence: *

Birth month: *

Birth day: *

Birth year: *

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Gender: *

Race/Ethnicity: *

Marital status: *

Spouse or Domestic Partner's Name:

Ages of children:

Tell us a little about your current car

Year of Vehicle:

Make, model, trim:

Miles:

Car Loan?:

Lending Institution:

Inspected?:

Monthly payment: $

Is your current car in need of repair?:

If yes, do you know the estimated cost?: $

Exact payoff and per diem: $

Do you have a valid drivers license in your state of residence?:

Can you drive a vehicle with a manual transmission?:

Income Information

Employer: *

Hours per week: *

Hourly wages: * $

Annual Salary: * $

Occupation: *

Start Date of Current Job: *

2nd Employer

2nd Employer:

Hours per Week:

Hourly wages: $

SSI: $ per month

SSDI: $ per month

TANF: $ per month

Child support: $ per month

Veterans Benefit: $ per month

Unemployment: $ per month

Other Income?: $ per month

Your credit history: More Than Wheels assists client with all levels of credit history.

Please just provide an honest assessment of your situation, your current credit situation will not have an impact on our ability to help you

Self reported Credit:

Car repossession:

Bankruptcy?:

Accounts in collection?:

Medical Bills in Collection?:

Income and Expense Worksheet

The purpose of the worksheet is to help us determine the amount of money you have available for a car. Working with a personal budget is part of the Bonnie CLAC process, so please do your best to answer these questions. If you need assistance to complete this section you may call a Bonnie CLAC associate.

Average Monthly Income

Monthly Net Work Income: $

Take home pay after taxes and deductions

Other Income: $

Monthly SSI, SSDI, TANF Social Security Income, Social Security Disability Income, Temporary Aid to Needy Families

Other Income: $

Total Monthly Net Income: $

Average Monthly Expenses

Rent or Mortgage payment: $

Property Taxes: $

Property Insurance: $

Electricity : $

Heat: $

Telephones: $

Cable/Satellite: $

Gasoline: $

Laundry: $

Groceries: $

Cigarettes/Tobacco: $

Pets/Animals: $

Daycare: $

Internet: $

Medical insurance and expenses: $

If not deducted from your pay check

Student Loans: $

Auto Insurance: $

Credit card payment: $

Other: $

Current car payment: $

Total Expenses: $

Available Income: $