Homeowner Interest Survey

Homeowner Interest Survey

This is not an application. All information collected is private and confidential. Information is used only by Habitat for Humanity of Madison County (HFHMC) and if requested by you, non-profit or government homeownership agencies/programs for the sole purpose of purchasing a home.

YOU MUST FILL OUT THE ENTIRE FORM IN ORDER FOR US TO PRE-QUALIFY YOU.

First Name:
Last Name:
Address:
City (Alabama):
Zip:
Email:
Home Phone:
Cell Phone:
Work Phone:
How many people are in your household?
How many children or others living with you who are 18 or older?

Please list your monthly income from any of the following (we MUST have this information to be able to tell you whether or not you qualify)

Job- Average Hours Per Week:
Job- Hourly Rate: $
Family Assistance: $
Food Stamps: $
Social Security: $
SSI: $
Disability: $
Alimony: $
Child Support: $ [actually received]
Other: $ [describe below]

Are You: Married
Separated
Divorced
Widowed
Single (never married)