Property Intake Form & Model Request

Property Intake Form and Model Request
Point of Contact (POC) Information
POC Name*

First NameLast Name
Company Name*
Contact Title*
Contact Title
Company/Owner Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
POC Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
POC Email Address*
example@example.com
Basic Property Information
Property Name*
Occupancy Type*
Ownership Entity*
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Status*

UnderwritingApplicationEstablished/OccupiedNew Construction
If property is not occupied, expected date of occupancy:

MonthDayYear
Date
LIHTC #*
LIHTC Type*
CMTS ID (TX Only)
FHFC Key # (FL Only)
Expected UA Implementation Date:*

MonthDayYear
Date
Intended 90-Day Notice Posting Date:*

MonthDayYear
Date
Are you applying for, or have you received Multifamily Direct Loans (MFDL) with the state (e.g. HOME)?*

YesNo
Are you applying for MFDL from another jurisdiction?*

YesNo
If "Yes", what jurisdiction:
Will there be HUD-Regulated buildings (other than those that are HUD Regulated due to MFDL)?*

YesNo
Will there be any RHS assisted buildings or tenants?*

YesNo
Unit Mix and Types

Rows	Unit Type 1	Unit Type 2	Unit Type 3	Unit Type 4	Unit Type 5
# of Bedrooms
# of Bathrooms
Unit Type
Total # of Units
Square Ft.
Current UA (in $)

Total # of Units*
Total # of Buildings*
Please check off all the items below that you have.*

Site PlansDesign DrawingsConstruction DrawingsAs-built/Record DrawingsConceptual DrawingsNone
File Upload

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Utility Information

Rows	Utility Type	Who Pays	Tenant Bill Paid To
Heating
Cooking
Water Heating
Air Conditioning
Other Electric
Sewer
Water
Trash

Rows	Name of Utility Provider	Units Metered By
Electric
Gas
Water
Sewer
Trash

Do you have will-serve letters from utility providers?*

YesNo
If 'Yes", please upload a copy of these letters:

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Will there be Solar PV or another alternate Energy Source?*

YesNo
If "Yes", please explain:
Current Utility Allowance Methodology:*
PHA Name
PHA Schedule Effective Date

MonthDayYear
Date
PHA Schedule Building Type
Energy and Water End Uses
Will units have washer/dryer hookups?*

YesNo
Will there be a common area laundry facility on site?*

YesNo
Will the property be providing washers/ dryers to tenants?*

YesNo
What is the type of lighting used in the units? (majority)*
Clothes Dryer Model # (exact or similar)*
Clothes Washer Model # (exact or similar)*
Refrigerator Model # (exact or similar)*
Dishwasher Model # (exact or similar)*
Water Heating Model # (exact or similar)*
Type of Heating/Cooling System (HVAC)
Cooling Model*
Heating Model*
We recommend the following plumbing fixture flow rates: Kitchen Faucet (1.5 gpm), Lavatory (1.0 gpm), Toilet (1.28 gpf), Shower Head (1.5 gpm). Please confirm below that you adhere to these flow rates or specify if you'll be incorporating different flow rates.*
If there is any additional information you would like to share with us, please provide it below:
IMPORTANT! If property is occupied, provide at least one tenant bill for each tenant paid utility. If the utility will be sub-metered, residents will be billed using commercial rates. Provide a full month's worth of all house electric bills. If water heating is provided by a natural gas central water heating system, please provide house natural gas bills. If water is a tenant paid utility, provide a full month's worth of all property water bills.

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The information provided in this form is accurate as of the date of signature and to the best of my knowledge. Please sign below:*
Should be Empty:

Property Intake Form and Model Request

Point of Contact (POC) Information

Basic Property Information

Unit Mix and Types

Utility Information

Energy and Water End Uses

Type of Heating/Cooling System (HVAC)