Morgan Auto Group Helping Hand Fund Application

Morgan Auto Group Helping Hand Fund Application

The Morgan Auto Group Helping Hand Fund (the "Fund") enables Morgan Auto Group dealership employees, partners, suppliers and friends to collectively support the needs of one another and the local community. The Fund is a charitable organization supported by donations from Morgan Auto Group dealership employees, suppliers and the public.

The Fund's mission is to provide confidential financial assistance to Morgan Auto Group dealership employees and others in the community during times of emergency when the need arises.

Part I

History with the Company

Today's Date

MonthDayYear

Current Position/Title*

How long have you held this position?*

What is your employment date with the Morgan Auto Group?*

Is it your first position with the group?*

Employment *

Supervisor*

Profit Center*

Dealership Name (Say "None" if SAC or other)*

How did you hear about the fund?

Part II

Family Information

Marital Status*

Are you the sole income earner in the household?*

YesNo

If no, please list other income earners and their job description:

Financial Information

Have you ever asked for help from the HHF before?*

YesNo

If yes, please state when the last assistance was from the fund?

Was the prior assistance a loan or gift?

LoanGift

What was the amount of the last assistance?

If the last assistance was a loan has it been paid in full as of this request?

YesNoStill Making PaymentsWas a Gift

Part III

Request for Funds

Please describe in detail the situation that brings you to the fund:*

How much is needed at present time?*

Is there a deadline for your need?

If this is an emergency related to utilities please attach the bill. If this is for medical care, please attach a doctor's note with estimate of cost. For any other requests please attach relevant invoice, receipt etc.

Attach A Relevant Document

Upload a File

Are you requesting: *

A GiftA Loan To be Repaid

Why?*

If the request is a loan please state the term in which you can repay?*

Please state the date when the first repayment can begin?*

MonthDayYear

I HEREBY CERTIFY THAT THE ABOVE INFORMATION AND ALL INFORMATION PRESENTED REGARDING MY REQUEST FOR ASSISTANCE IS CORRECT. I UNDERSTAND THAT ANY DELIBERATE MISREPRESENTATION OR WITHOLDING OF FACTS WILL BE CONSIDERED FRAUDULENT AND WILL BE GROUNDS FOR DISQUALIFICATION.

Signature Instructions: If you are on a Desktop Computer please use the mouse to write your signature if you are on a mobile device you can use your finger.

Signature*

Part IV

Personal Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Area CodePhone Number

Mobile Number*

Area CodePhone Number

E-mail*

Date of Birth*

MonthDayYear

Sex*

MaleFemale