FHF Client Intake Form
Date
/
Month
/
Day
Year
Date
Time (AM / PM)
Name
First Name
Last Name
Home Phone
Email
example@example.com
City
Race
Am Ind/ Alsk
Am Ind/Alsk & Black
Am Ind/Alsk & White
Asian
Asian & White
Blk/ Afr Am
Blk/ Afr Am & White
Pacific Islander
White
Other
Ethnicity
Latino
Non Latino
National Origin
Language Spoken
Type of Client
Homebuyer Realtor
In-place Tenant Property Owner
Landlord/Manager
Management Company
Realtor
Property Owner
Rental Home-seeker
Other:
Income Amount
Number of People in Household
Address
Street Address
Street Address Line 2
City
State / Province
Zip Code
Comments
Female Head
Yes
No
Disabled
Yes
No
Senior Citizen
Yes
No
Is this regarding an Unlawful Detainer (UD)
Yes
No
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