AFFORDABLE HOUSING APPLICATION

Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a U.S. Citizen or legal resident? *

Yes

No

Are you employed? If yes, provide Employer's Name *

Yes

No

Do you receive any public assistance? *

Yes

No

Will you be a first time home buyer? *

Yes

No

What would be your desired purchase date to move in?

MM

DD

YYYY

Do you have any outstanding loans or debts? *

Yes

No

Do you have a savings account? *

Yes

No

Have you ever filed for bankruptcy?

Yes

No

Are you currently facing eviction or foreclosure? *

Yes

No

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false information may result in my application being denied. *

Acknowledge