Date (mm/dd/yy)
Work Phone
Home Phone
Applicant Name
Social Security #
Co-Applicant Name
Social Security #
Mailing Address:
City/State/Zip Code
Please check
box if you are
Hispanic or
Latino.
Is anyone in your
household disabled?
Number
of
Dependents
Are you a
U.S. Citizen?
Other:
Own:
Rent $:
Current Living Situation:
HOUSEHOLD AND INCOME INFORMATION
(Please include information on everyone in household)
Name:
Date of Birth (mm/dd/yy)
Length of Employment:
Gross Annual Income:
Name:
Date of Birth (mm/dd/yy)
Length of Employment:
Gross Annual Income:
Name:
Date of Birth (mm/dd/yy)
Length of Employment:
Gross Annual Income:
Name:
Date of Birth (mm/dd/yy)
Length of Employment:
Gross Annual Income:
List any additional income
Including Food Stamps or
Child Support if applicable.
Child Care Expenses:
Debt Information: List all debts (car payments, furniture, credit cards, student loans, bank notes, etc.)
Do not include living expenses, such as rent and utilities.
Creditor:
Monthly Payment:
Balance Owed:
Creditor:
Balance Owed::
Monthly Payment:
Monthly Payment:
Creditor:
Balance Owed:
Monthly Payment:
Balance Owed:
Creditor:
Monthly Payment:
Balance Owed:
Creditor
I affirm that all the answers given in this pre-application are correct and made for the purpose of obtaining credit. I authorize Deep Fork
Self Help Housing to communicate with any person, firm or corporation needed, including Rural Development, to obtain such information
as may be required concerning the statements made in this pre-application interview and agree that the pre-application shall remain the
property of Deep Fork Self Help Housing whether or not the loan herein requested is granted
.
Please type your name(s) in the box(es) to signify you have signed the form.
Signature:
Signature:
Your email address:
Comments:
Fill out this Pre-Application to take the first step toward your new home.
Deep Fork Self-Help Housing
Helping Families. Building Futures.