FIRST HOME CLUB
HOMEBUYER PROGRAM REGISTRATION FORM
(Please be sure to complete the application,
sign and date it, and return it with all the necessary documentation. IRS Form
1722 may be substituted if tax returns for the previous three (3) years are
unavailable.)
Personal Information
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Applicant |
Co-Applicant | ||
| Name: | Name | ||
| Street Address: | Street Address: | ||
| City: | City: | ||
| Zip: | Zip: | ||
| Home Phone: | Home Phone: | ||
| Work Phone: | Work Phone: | ||
| Age: | Age: | ||
| SSN: | SSN: | ||
Dependent Information
| List Dependents, Age and Sex (Not Including Names Above) | ||||
| Name | Age | Sex | ||
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Employment Information |
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| Applicant |
Co-Applicant |
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| Employer: | Employer: | ||
| Job Title: | Job Title: | ||
| Start Date: | Start Date: | ||
| Hours Worked Per Week: | Hours Worked Per Week: | ||
| Hourly Rate: | Hourly Rate: | ||
| You Are Paid Every: | You Are Paid Every: | ||
| Gross Wage Per Month: | Gross Wage Per Month: | ||
Income
|
Applicant's Other Income |
Co-Applicant's Other Income |
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| SSI, SSD, SSA: $ | SSI, SSD, SSA: $ | ||
| Child Support Per Week: $ | Child Support Per Week: $ | ||
| Alimony Per Month: $ | Alimony Per Month: $ | ||
| Pension Per Month: $ | Pension Per Month: $ | ||
| Part-time Job Per Week: $ | Part-time Job Per Week: $ | ||
| Part Time Employer and | Part Time Employer and | ||
| Address: | Address: | ||
| How Long at Part-time Job: | How Long at Part-time Job: | ||
| Part-time Job Title: | Part-time Job Title: | ||
| Total Monthly Income: $ | Total Monthly Income: $ | ||
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| Applicant's Bank Accounts | Co-Applicant's Bank Accounts | ||
| Bank: | Bank: | ||
| Account #: | Account #: | ||
| Balance: $ | Balance: $ | ||
| Bank: | Bank: | ||
| Account #: | Account #: | ||
| Balance: $ | Balance: $ | ||
| Bank: | Bank: | ||
| Account #: | Account #: | ||
| Balance: $ | Balance: $ |
Monthly Debt
|
Applicant |
Co-Applicant |
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| Creditor: | Creditor: | ||
| Account #: | Account #: | ||
| Monthly Payment: $ | Monthly Payment: $ | ||
| Balance: $ | Balance: $ | ||
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Monthly Debt Continued |
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|
Applicant |
Co-Applicant |
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| Creditor: | Creditor: | ||
| Account #: | Account #: | ||
| Monthly Payment: $ | Monthly Payment: $ | ||
| Balance: $ | Balance: $ | ||
| Creditor: | Creditor: | ||
| Account #: | Account #: | ||
| Monthly Payment: $ | Monthly Payment: $ | ||
| Balance: $ | Balance: $ | ||
| Creditor: | Creditor: | ||
| Account #: | Account #: | ||
| Monthly Payment: $ | Monthly Payment: $ | ||
| Balance: $ | Balance: $ | ||
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| Applicant | Co-Applicant | ||
| Monthly Rent: $ | Monthly Rent: $ | ||
| Monthly Utilities: $ | Monthly Utilities: $ | ||
| Landlord: | Landlord: | ||
| Landlord Address: | Landlord Address: | ||
| Landlord Phone #: | Landlord Phone #: | ||
| Rent Due Date: | Rent Due Date: | ||
| Date of Last Payment: | Date of Last Payment: | ||
| Have You Ever Been Late? | Have You Ever Been Late? | ||
| If Yes How Many Days? | If Yes How Many Days? | ||
Credit History
|
Applicant |
Co-Applicant | ||
| Ever Filed for Bankruptcy? | Ever Filed for Bankruptcy? | ||
| If Yes, What Chapter: | If Yes, What Chapter: | ||
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Explain Bankruptcy: |
Explain Bankruptcy: |
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Credit History Continued |
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Applicant |
Co-Applicant | ||
| Any Judgments Outstanding? | Any Judgments Outstanding? | ||
| If Yes, With Whom: | If Yes, With Whom: | ||
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Explain Judgments: |
Explain Judgments: |
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| Any Collections Outstanding? | Any Collections Outstanding? | ||
| If Yes, With Whom: | If Yes, With Whom: | ||
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Explain Collections: |
Explain Collections: |
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| Obligated to Pay Child Support? | Obligated to Pay Child Support? | ||
| If Yes, How Much Per Week: $ | If Yes, How Much Per Week: $ | ||
| Have You Ever Owned a Home? | Have You Ever Owned A Home? | ||
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If Yes, Explain: |
If Yes, Explain: |
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I/We hereby authorize the approved counseling provider to request any
information they deem necessary to determine my/our eligibility for this
program, pertaining to employment, credit, real estate, mortgage financing,
utilities, rent history, etc. The approved counseling provider may employ and
lawful means to verify any information about me/us. I/We hereby authorize the
approved counseling provider to share any information they obtain about me/us
with the lender, government, nonprofit, and other entities or individuals.
My/Our receipt of any or all related services or assistance from the approved
counseling provider does not guarantee a mortgage loan, house, or any tangible
benefits.
THE UNDERSIGNED DO HEREBY CERTIFY THAT ALL THE INFORMATION PROVIDED IS TRUE AND
ACCURATE TO THE BEST OF THEIR ABILITY.
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*SIGN ONLY AFTER YOU HAVE RECEIVED YOUR IN OFFICE INTERVIEW |
| APPLICANT'S SIGNATURE |
DATE |
CO-APPLICANT'S SIGNATURE |
DATE |
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