Bend-Redmond Habitat for Humanity ®
This form is NOT considered an application for the housing program
Along with this form please turn in 1 recent paystub copy or verification of income for each customer.
Note: All adults over 18 years old, living in the household must submit financial documents so that we can calculate household income levels.
PRIMARY CUSTOMER EMPLOYMENT - Last 2 Years
Co-Customer EMPLOYMENT - Last 2 Years
Please list the approximate value/current balance of the following:
I authorize the Housing Counseling Staff of Bend-Redmond Habitat for Humanity to: (a) pull my/our credit report (soft pull; will not affect your score) to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property; (b) pull my/our credit report (soft pull) and review my/our credit file for informational inquiry purposes; and (c) obtain a copy of the HUD-1 Settlement Statement, Appraisal, and Real Estate Note(s) when I/We purchase a home, from the lender who made me/us a loan and/or the title company that closed the loan. I/We understand that any intentional or negligent representation(s) of the information contained on this form may resultin civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001.