Client Intake Form

Client Intake Form

NHS/Lifted Cares
Welcome!
We are excited that you have selected NHS/Lifted Cares to join you in your home purchase journey. Please not that completion of the form and payment will result in a Soft Credit Pull via Credco. If you have questions before completed please text or call 504-612-1267 with your questions.
Contact Information
Applicant

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Phone Number
Please enter a valid phone number.
Alt Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Upload Proof of Identification

Drivers License/State ID/Passport
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Client Intake Form

NHS/Lifted Cares
Are you pre-approved by a Lender
Lender Information
Upload Your Pre-Approval Letter

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Have you owned a home in the past 3 years

Client Intake Form

NHS/Lifted Cares
Are you a US Citizen
Are You A Veteran
Are you Active Military
Marital Status
Gender
Race
Ethnicity
Highest Level Education

Client Intake Form

NHS/Lifted Cares
Employer Name
Employed 2 or more year
Monthly Income
Before Taxes
Annual Income
Before Taxes
Upload Proof of Income

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Current Housing Status
How Many in Household
Current Rental Amount
Are you on Section 8
Head of Household
Are you on Section 8?
Referral Information/How did you hear about us?

Client Intake Form

NHS/Lifted Cares
Co-Applicant

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Social Security Number
Phone Number
Please enter a valid phone number.
Email
example@example.com
Employer
Proof of Identification

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Monthly Income
Before Taxes
Annual Income
Before Taxes
Proof of Income

30 days/Check Stubs/Tax Returns/Award Letter
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Client Intake Form

NHS/Lifted Cares
Signature

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